Can HR 3200 Be Fixed?

Health care reform looks like it’s stalled. And rightly so, based on the provisions of the House Democrats’ health care reform bill. The grossly misnamed America’s Affordable Health Choices Act (HR 3200) combines the worst of all possible worlds: high taxpayer costs, big increases in federal deficits, and disincentives for businesses to hire, while leaving up to twenty million individuals still uninsured and doing little or nothing to control runaway national health care expenditures.

Although the bill would make health care coverage available to many of the millions who currently cannot afford it, its provisions will potentially add some $200 billion a year to federal expenditures, make only miniscule reductions in Medicare cost trends, and impose play-or-pay provisions and a new surtax that could hurt smaller businesses just as they try to recover from the recession.

So, is there anything that can be done to fix HR 3200 so that it would provide affordable universal health care coverage without increasing federal deficits or halting the recovery from the recession?

The answer is that major changes—some paralleling those in the Wyden-Bennett Healthy Americans Act—are needed in four areas of the bill, those relating to the proposed insurance exchanges, the individual mandate, Medicare, and costs and financing.

The proposed insurance exchanges should be redesigned to maximize the size of the resultant pools and to achieve the benefits of price-competition. Insurers should be required to offer “best value” to the exchanges—with exchange participation a requirement for selling any insurance—to discourage “cherry picking” outside the exchanges through direct marketing to selected employers. Basic coverage should be set by a board independent of Congress to minimize the impact of provider lobbying. Insurers, in turn, should be protected from extreme adverse selection, through exchange-sponsored reinsurance or risk-adjustment. A public plan option should be implemented only in states where insurers fail to control the premium rates offered through the exchange.

The individual mandate should be changed from an after-the-fact penalty for non-insurance—an approach likely to result in both litigation and cheating—to advance selection from a choice of an ERISA-compliant employer plan, participation in an exchange, or a buy-in to a low-cost option tied to Medicaid (the existing public plan). Those failing to make a selection—expected to be primarily the young and healthy—would be automatically enrolled in the low-cost option. Premium collection would be simplified by combining it with income tax withholding, as proposed by the Wyden-Bennett bill. Lower-income individuals’ payments would be partially offset by tax credits or subsidies, but these should be tied to the low-cost option buy-in rate in order to reduce costs to the federal government.

Medicare payment policy responsibility should be transferred to a board independent of Congress—as proposed by White House Budget Director Peter Orszag, with the grudging concurrence of some Democrats—with payment policy authority covering both rates and controls over some of the more egregious provider profit-maximizing practices.

Federal costs and financing needs should be considerably less onerous with these changes, although allowing buy-in to a low-cost option tied to Medicaid implies more demand for already limited resources, so that higher payment rates for scarce providers may be necessary (as provided for in the present version of HR 3200). Although the concept of the play-or-pay mandate is fair in requiring all employers to contribute to the cost of coverage, the “pay” levy should be lower for small businesses. At the same time, two funding sources previously rejected by House Democrats should be tapped: employer-paid benefits above those guaranteed as “basic benefits” and available through the exchanges should be taxed, thereby also discouraging excessive demands for care, while “unhealthy consumption” should be restrained by taxes on certain soft drinks and candy and by higher levies on tobacco and alcohol.

Together these changes would rearrange and simplify the health care landscape, making affordable coverage more truly available while bending the cost curve. Universal coverage would be assured since anyone not making an insurance selection would be automatically enrolled in the low-cost option. Issues of payment-avoidance or penalties for non-compliance would not arise, since coverage payment would be part of regular withholding. Major employers’ self-funded arrangements would be left in place, while other employers and their employees would have a new range of competitive options. Market competition would be maximized by the insurance exchanges’ large pools and limitations on cherry-picking and adverse selection. Consumer responsibility would be encouraged by the requirement to make choices of coverage to meet individual needs. Medicare payments and non-Medicare benefits would be freed from political interference. Costs would be more fairly distributed between employers, individuals, and government—without increasing the federal deficit or undercutting businesses’ ability to recover from the recession.

Is it likely to happen? Probably not, any more than the provisions of the Wyden-Bennett bill are likely to be adopted. And the result that we will have to face? A choice between unaffordable “reform” that sabotages the economy, and no reform at all.

Roger Collier was formerly CEO of a national health care consulting firm. His experience includes the design and implementation of innovative health care programs for HMOs, health insurers, and state and federal agencies. He is editor of Health Care REFORM UPDATE.

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55 replies »

  1. I on the other hand, disagree with Collier. For decades we have allowed insurance companies to use the capitalist model to compete amongst each other. In the end, insurance company premiums have skyrocketed and they continue to either exempt those with pre-existing conditions or charge excessive premiums. Those who regulate the insurance company industry are virtually non-existent. Allowing insurance companies to compete with each other is a guarantee to maintain the status quo.

  2. I have read H.R. 3200, and it is a mess. It will not achieve the stated goal, only claiming to add a small portion of uninsured, while removing coverage for a significant number of currently insured folks (all of them after the 5-year grace period).
    Also, if Medicaid is the model, availability of Medicaid providers will be a worse problem than it is now.
    The cost is staggering. The additional administrative costs alone will make health care much more expensive. Current estimates at 2 trillion, which we all know will increase tenfold over time. I’d rather suffer temporarily while we find a better solution than make my children suffer.
    The ‘public option’ is Orwellian. The government control it puts in place frightens me.
    See H.R. 3400 for alternatives.

  3. Our congressional representatives are a disgrace to this country. Yes, Democrats and Republicans alike. Neither party is even talking about actually solving the underlying “real” problems with our country.
    Get rid of the greedy lawyers, special interest groups, lobbyists and corrupt government officials and you won’t have outlandish malpractice claims and suddenly the cost of healthcare becomes market driven.
    I have yet to hear one congressperson state that they are willing to accept the same healthcare package that they are trying to force down the throat of the American people.
    We need to clean house in 2010. We’re a country governed by greedy, egotistical idiots!

  4. This notice is at the top of the site noted above for the bill :
    ATTENTION! – The text in this section originates from a work-in-progress by the U.S. Congress. As a result, there may be missing or inaccurate information within the text posted here.
    How can we make “informed” opinions if this is the information we get ???????

  5. Having read a good bit of the bill myself, I have to agree with Balmy. HR3200 as it was released to the public in July, DOES permit competitive private companies to operate along side the government’s public option. HOWEVER, there are considerable stipulations required for a private company to be considered plausible and register for the new Health Insurance Exchange. I won’t go into these in detail here, but you can read for yourself these stipulations here: http://www.newhealthcareplan.com/frontend/TableOfContents/ and reading through the Subtitle B, C, and D.
    The really ugly part of this bill, is the fact that it has been put together so hastily, that they’ve not been able to properly write the bill in full. As a measure to get the bill passed quickly, they’ve written in the role of the Health Choices Commissioner. This role (in short,) gives this yet-to-be-appointed commissioner near god power over the bill itself, the ability to specify the parameters necessary for an insurance company to comply with the Health Exchange itself and MANY MANY other KEY decisions related to the program.
    This Commissioner role will have incredible power over the program, especially as it relates to private insurance companies. If we all use history itself as a guideline (as Balmy has done above,) then we can easily see just HOW badly things can go wrong here in such a short amount of time.
    Personally I don’t think the bill is ALL bad in its INTENTION. However, it does an extremely poor job of defining and locking down the methods by which this program ACTUALLY operates and instead leaves this grand task to the onus of a single individual… Decide for yourself how this is going to play out.

  6. Am I misinformed ? I thought that the Congress and Senate ARE covered by a competative list (their choice) of 111 insurance companies that have contracted with the government.

  7. The projected cost of the plan will be grossley underestimated. History shows the cost will be at least two to four times the estimated cost.
    The Post Office, Amtrack, and VA health care are text book examples of government managed programs.
    Amendments will be added in the dark of night to achieve the socialist program desired.
    There are hundreds of billions of dollars of fraud and corruption in Medicare/Medicaid that the government can not provide oversight to control. Just imagine what will happen in a national health care program.
    The answer to most of the cost problems can be solved be the followin steps.
    1. Allow insurance companies to compete interstate.
    2. Discontinue free health care to illegals.
    3. Repeal the Anchor Baby Law.
    4. Demand stringent oversight by Congress on the fraud/corruption of current government health care programs.
    Demand our Congress and Senate to join a competitive program the same as every one else.
    END OF STORY

  8. Having been an RN and now being a senior on disablility, I see many things wrong with HR200. I have not completed reading it, to be honest. I have read many articles pro and mostly con.
    I have great concern about no mention of quality care, only the bottom line money. And from many resources that bottom line appears to be going up .
    Governmental control over the entire system takes away our privacy and our right to choose to what type of health care we wish to have. Ideally it would be wonderful for everyone to have coverage. However, some don’t want it. Some prefer alternative care.
    We need to rid the system of it’s flaws, fraud, waste and treatment of illeagal immigrants. I am not cold hearted, but illeagal means you should not be here. Giving them health care not only drains on our citizens, it only encourages more to come for the best care in the world. It costs us dearly. If they are illeagal, I have no problem with stablizing them one time and the sending them back home. It should end there. If the government feels it is to difficult to keep up with illeagal immigrants than maybe that is where some work needs doing.
    Having spent many years as a Hospice nurse, end of life care again should be a choice, not a review. It is also unneccesary to set up such a provision. Most,if not all, Patients receive directives information when they are terminally ill. They also receive counseling and options for treatment or are informed that comfort care is all that is left now and types of that care are given to them to choose from. These patients are of all ages from children to the elderly. The elderly, usually have made these decisions by the time the are
    elderly.
    I also note that I see nothing that improves the health care for mental illness. Most of these doctors receive only 50% from medicare, while all other specialities receive 80% and many private insurances do the same.
    This and any bill that is 1000 pages long and hard to read by the average citizens,is too full of confusion and loop holes. This bill should not pass
    I know the President has spoken with AMA and Pharmaceutical companies, has he spoken to RNs?

  9. To Allen and Anna- First, Allen, thank you for your very knowledgable insight into this bill. Anna, I didn’t read anything about a “death panel”, but I did read where payment will not be paid to a hospital for any incident that occurs more than once in a fiscal year. Elderly have numerous bouts of pnuemonia or other ailments in a year, but with this bill, payment will not be made. What about that small child who suffers from sickness due to cancer? Who then pays? Will the hospital refuse to take them? Then what?
    I just finished radiation for breast cancer. I had to have numerous surgeries–all for the same incident. My radiation cost $36,000. I have medicare and a supplemental insurance. My portion of the radiation alone will be $10,000. Read the letter from the Committee on Ways and Means to the Honorable Charles Rangel. In there it states that by the year 2019 the deficit from this bill will be $1,042 billion and there will still be 17 million nonelderly not covered by insurance. I don’t want to pay my 10,000 debt let alone any part of a 1,042 debt nor do I want my kids to have to pay it.

  10. I’m not a fan of the new bill for several reasons, but would people please stop with the “death panel” bs! NO, Linda Daniels, you will not be asked to commit suicide. Have you actually read that page or are you just parroting what Betsy McCaughey (who is a part of the Hudson Institute which gets funding from bio tech co. and insurance companies) and Palin? It’s late years counseling, a medical counseling service that helps you make treatment decisions, write a living will, state whether or not you want to be revived, etc. Some people don’t want to spend 15 years in a vegetative state on a feeding tube (see Terri Schiavo). If that happens to me, I want to be unplugged, I want me or my family to be the ones to make that decision, NOT religious organizations, because it’s none of their damn business, and I don’t care what their god says about the matter. The people that actually believe end of life counseling means a death panel that forces suicide are completely psychotic, and it freaks me out that you are allowed to walk the streets. I mean, seriously, do any of these people actually do any research before they let themselves get all wound up into an irrational ball of hate and anger? They just want something to hate so badly, that they are willing to blindly believe any rumour. They are willing to believe a rumor, but too lazy to research it on their own, and then eager to spread their hate and lies. I am so so sick of it. After tackling healthcare reform we should tackle public education, because apparently a lot of people are completely unable to read.

  11. “If this bill passes and I need medical care I will be ask to commit suicide.”
    The bill permits seniors, IF THEY WISH, to consult with their physician to discuss end of life issues and that Medicare MUST pay for this consultation but not more often than once every 5 years. IT DOES NOT SAY SENIORS MUST CONSIDER SUICIDE !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    End of life issues is not only ending your life but HOW you want it to end which is mandated by what you put in your Living Will, Durable Power of Attorney etc. which should be done in consultation with your MD.
    Seniors will NOT be denied medical care because of their age !!!!!!! Do any of you think our congressmen and women are going to pass a bill that would kill their chances of us voting them back next year ?????

  12. Being a senior, I am more practical by nature of grey hair I guess. but, I want to find out in Health Care Bill HR3200 how they propose to revamp the pay out for medical care for seniors. Present form, Medicare pays 80% for medical services and the remaining 20% is to be paid by the Medicare senior. This leaves 20% of the burden to be paid out of pocket. Most seniors who can afford it, purchase supplemental insurance plans to cover this 20% not covered by Medicare.
    This supplemental insurance can cost from $100 to $400 a month. With the HR3200 passed and in force, would this private supplemental insurance be forbidden?
    I wonder how this HR3200 would impact the “freedom” to buy supplemental insurance the seniors have now?
    Maybe with the new law, we would have to forgo the supplemental option and be forced to pay the 20% medical cost out of our own pockets.
    Does anyone have any information on this portion of the health plan?
    Thank You !!

  13. Coleen, This bill does not address any specifics as to care, it only addresses the management of the government intervention to try and control cost of the private sector and provide a cheaper option to uninsured americans.

  14. I’ve been working since I was sixteen. Always saw the medicare taken out my pay check every week. I always though medicare would be there when I needed it to retire. If this bill passes and I need medical care I will be ask to commit suicide. Page 425 of the health care bill. You are playing God. Sure the medicaid and some health insurance need some work. Not what you are planning to do to the American people. May God have mercy on you.

  15. Teresa
    I read page 58, WOW this bill has got to be killed.
    Granted something should be done to help the people that can not be insured, but this is not the way.
    How do you feel about the 2.5% employeers will be taxed if they don’t have health care for employees, sounds like blackmail to me.
    I feel this bill is opening Pandors box, if it passes we and our future generations will have to pay not only in $ but in health care.
    Oh by the way it is now called Health Care Insurance
    Reform.
    When they first started with this it was called a National Health Care System later and now is refered to as International Health Care Reform, International to me refers to world wide. ??????
    Response will be welcomed.
    Barbara

  16. Regarding VA care : My husband was a veteran on the Korean Conflict. I accompanied him on all of his visits during our 5 year marriage at VA hospitals. Never once did we experience unreasonably waiting times compared to private physicians. In fact I always spent more time waiting for my appointments than he did. Our experiences were at several VA sites. His care was wonderful, thorough and fast.

  17. Steve – see page 58 of the bill -this addresses the issue relating to the government having access to your financial information.

  18. The general public who are oblivious to HR 3200 need to know what it entails. The actuality of it needs to get out so it can be heard. People need to be informed, and they need to know what is actually going on with this bill. Go to http://www.buythebill.com to get a free PDF download of the bill, or you can purchase a printed and binded hard copy of the bill. Again, that’s http://www.buythebill.com

  19. Too little has been said regarding the ill defined term “quality”.
    For instance, provider (ugh) payments are to be based on quality of service, not upon service alone or conformity to a service code number. Who defines this? Is it based upon outcome, suggesting that an undesirable outcome implies low quality? Is an incorrect or incomplete diagnosis “low quality”, hence unreimbursable?
    The recently reiterated number of hospital deaths ascribed to “mistakes” is a grand departure point for this. The implication is that an undesired outcome is the result of a mistake, not simply the inevitable process or unavoidable consequence. Antibiotic resistant infections are not “mistakes”. Readmission does not always reflect failure.
    Such interpretations are sure fire ways to restrain costs. And to define stupidity.

  20. LET YOUR VOICE BE HEARD!
    The website below is a nationwide effort to let Washington hear from the American taxpayers on this healthcare reform bill. We are requesting time to review HR 3200, and to be able to debate the effects of this bill. The petition will be delivered to the Senate and to the President. http://www.youcanstopobama.com.

  21. The problem I see with this bill is it puts government into the decision making of what can and what cannot be covered. It gives the authorityto the employer to atomatically enroll an employee in heatlh care provided by the company if they do not opt out. This is a degration of our rights as citizens. Healthcare is not a right by our constitution it is a privelage. This bill only grows government to manage health care in the United States. The jobs that would have to be created to run this program are enormous and given the governments history of running anything there would be 3 times as many jobs created to manage and oversee not only the private helath care system but to oversee the government health care system.
    This bill does not address anything as to what will or will not be covered. By the text in this bill that will not be decided and not required to be decided until 1 year after passing this bill.
    How can we pass a bill on healthcare when it does not address coverage only the creation of government agencies and additional responsibilities of goverment agencies that cannot manage Medicare at this point in time it only address government oversight and enforcement of coverage of whatever is decided later.
    This bill if read lays the ground work for bigger government to oversee the private industry. Bigger government to run a public health care system by the government. Creates a lot of reports to show accountability by these government agencies that will require more government employees. Also will create agencieis to oversee and watch that the government will not do anything wrong. It also progessively gives power to the Secretary to reallocate funds to these programs from other agencies within the government through the year 2019 increasing a minimu of $6M each year. What other government agencies would have these funds just sitting around not being used? I say Social Security would take a hit, what about all the money for small businesses to startup.
    The WH claims that people are losing their healthcare benefits everyday and it is because of the current health care system is not affordable. My twist on that is the reason why it is not affordable is because people do not have a job to pay for it. I would say when given the option of a company provided healthcare or a state provided healthcare if eligibile the people will take the state, because it is cheaper. The coverage is out there and people are willing to pay for it, but they cannot because they are out of work. Get the people back to work first then tell me that people don’t have health coverage.
    I am an example of Government healthcare, I am a veteran and most of the people I know paying for healthcare today would not be happy with the lines and the waiting period to see a doctor that I have to put up with when I go to the doctor at the VA. I injured my back while serving in the military, the treatment for by back pain is pain medication and device to assist me with putting on my socks, see most days I can’t bend down and put on my socks so the VA gave me a sock spreader with extended reach so I wouldn’t have to bend down to put on my socks.
    Good luck America on your upcoming experience of Government ran Healthcare.

  22. Barry,
    I am a highly trained kidney doctor who, along with all my colleagues, are paid by Medicare or with Medicare rates paid by private insurers. Finding doctors who accept medicare is not the problem. The problem is the extreme profits of the insurance companies.

  23. Can anyone substantiate a rumor I heard (I can’t remember where) that the government would have access to our electronic banking and could deduct any funds they felt we owed without our consent?
    Steve

  24. I am told that people who are diabetic and make the mistake of going off a diabetic diet, will not have coverage.
    I am told smokers will not be covered for things they have related to smoking.
    Can anyone direct me to the location of this data in the bill?

  25. No bill should be passed until all legislators are the first to enter the program. Period. The entire difference is commitment. Our august lawmakers are like the chicken and the general populace is like the pig when it came to breakfast; the chicken is involved, and the pig is committed. If they won’t commit, the bill should not be passed. Enough of their double standard.

  26. Collectively, we already spend too much per person for medical services. Raising taxes to finance 1/3 of additional cost for the new public plan insurance proposal is rediculous, even if the proposed savings finances the other 2/3s — which assumption is not proven (i.e. not evidence based.)
    Rather we must find a way to reduce fraud, waste and abuse in our public programs, before we add more government money (if ever). I propose several ideas for public programs:
    1. Require a bond for non-licensed providers in case of fraud.
    2. Limit self-referrals for tests.
    3. Audit peer review for effectiveness and supply outside reviewers when needed.
    4. Provide for tort reform in exchange for participation in Medicare.
    5. Require a bond for licensed providers who overcharge Medicare more than $10,000 in any year, after appeals are exhausted.
    6. Collect data on end of life services for the purpose of better public policy to ration irrational care and reduce futile care.
    7. Collectively negotiate for drugs.
    8. Chop up physician servioces into categories (e.g. cancer care), each with its own budget.
    9. Provide a lifetime ceiling for cancer care and cardiovascular services.
    10. I recommend readers to post your ideas to reduce waste, abuse, fraud, and control payments for futile care at the end of life.

  27. End of Life care is way to much Power to be placed in the hands of the Government !!!!!! This needs to be between families and Family Doctors , and the right of the terminally ill to choose their treatment over hospice be FREE from Government intervention !!!!!!
    thomas.loc.gov
    click on HR 3200 at the top of the page in red
    click on text
    and, then, click on Section 1233
    This is way to much authority to be placed in the hands of the Government .
    We need more options of choice from more providers , not just a Government option only as the alternative , Rules for health care providers
    enforced , but more insurance providers , with a Guarantee system say like the Banks have with FDIC making sure the coverage is met in the event a provider fails .
    read and learn more about the con job that sold American workers down the road , and who was the leading con in the job exporting policy maker position , , they sold out the American Dream , good wages and health care in 1994-5 with that WTO Free Trade agreement , and now have saturated our markets with all the imported stuff . We had the best Wealth Redistribution with the Mom and Pop retailers , but the Wall Street bunch conned the GOV into allowing the Trade rules to be lifted , Big Box and multi-national importer/retail to move in and crush the little retailers , consolidate the wealth , and we got what we got today , a consolidated wealth problem , read here and think was it all planned to end this way and make the people dependent on Government ????? ;
    The High Cost of the China-WTO Deal: Administration?s own analysis suggests spiraling deficits, job losses
    By Robert E. Scott 02-01-00
    http://www.epi.org/publications/entry/issuebriefs_ib137/
    more examples of wealth consolidation here;
    http://www.nytimes.com/2008/01/31/us/politics/31donor.html?ex=1359435600&en=33a4d96a239655bf&ei=5088&partner=rssnyt&emc=rss

  28. Subject: way to much power over elderly care
    they are really trying to limit access to the site with a ” Time out on the page where the 1233 section , but you can goto it this way ,
    thomas.loc.gov
    click on HR 3200 at the top of the page in red
    click on text
    and, then, click on Section 1233 that describes the Advanced care program , you have to reboot the page to get it to view , but this part here is very suspicious , it allows the Secretary to Limit the decisions of right to continue life supporting measures , , `(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–
    `(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
    `(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
    `(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision maker (also known as a health care proxy).
    `(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State–

  29. Why not bill the foreign countries for all all the illegal invaders that are using our hospitals and schools? Socialism has failed in every country through out history. If this bill passes I believe terminally ill seniors who are denied life prolonging medical treatment should remember the actions of Jack Ruby.

  30. I agree – this thing is a monster!! And very confusing for the average individual (like me!!) But it’s found in Sec 1173A Standardize Electronic Administrative Transactions and the part that concerns me is paragraph D, which reads:
    “enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;”
    I know somewhere else in the plan I saw mention of a National Health ID Card, but I can’t remember where else it was referenced.

  31. Leasa, I have not finished reading HR3200, although it will change I am sure. If other legislation is any indicator of how much worse this monster will be we will see an additional 300-500pages in the middle of the night. Anyway, were in the legislation did you read about the Health ID cards? I would really like to read that portion of it myself?

  32. Free clinics. It would help a lot. Would not dismantle our current system. Would provide jobs in construction and medicine, and health care to people who can’t afford it.

  33. I’ve read through most of the bill, and it truly disturbed me. I’ll be the first to admit that we DO have to address the problem of health care: there are TOO many Americans who can not afford medical insurance and the costs keep sky rocketing. This bill addresses only part of the first concern and makes the second concern worse by adding an enitrely new governmental agency to “mandate” our health care choices. The only price? Not only with this bill will we give up every expectation of HIGH QUALITY care, we give up every single expectation of privacy when it comes to both our finances and our own bodies. I for one do not want the government to have a say on how I CHOOSE to be treated medically, nor do I want them to have any say whatsoever on what life saving measures are taken at my “end of life”. In addition, has no one else noticed the mandatory national health id cards that will “assess a person’s financial ability to pay at point of sale”. Does this truly imply it will be tied to my bank account?

  34. Whoever “Freedom” is that wrote the comment about people not having insurance and they should die and their families too? Are you serious? What is wrong with people? Tats why that person left no contact info: because he is a legitimate psycho and would never under this bill get any help. Read the bible if you believe if Jesus so – those are not HIS words or thinking!

  35. Why cant those members of congress, most of which may be legal beagles, just come up with a simple 10 phrase bill which would identify what you can have, when you can have it, and how much will it cost?
    Enough of the party of the first part, who is a member of the second part, and not of the third…….

  36. Actually, both Peter and Genny are right. devon, we can seek peace while still striving for what we feel is best. If we say or do nothing, then we get what we deserve.
    You know, often we suffer from an excess of dualism in our culture. Just because something is wrong does not mean the opposite is right, or that there are only two options.
    Healthcare would benefit from a number of changes. HR 3200 is not beneficial.
    And yes, I read the whoooooole thing.

  37. “I’m scared to death of it becoming law and destroying our health care system as we know it.”
    Please stop worrying Genny and seek some peace in your life.

  38. “I’m scared to death of it becoming law and destroying our health care system as we know it.”
    The healthcare system as I know it needs to be detroyed.

  39. How can we stop this bill from becoming law? Seriously, what can we do? I have been writing to my representatives (and other reps as well) on a daily basis but I know my concerns fall on deaf ears. How can we, as concerned citizens, organized to stop this damn thing?
    I’m scared to death of it becoming law and destroying our health care system as we know it.

  40. This Bill is full of penalties, an example from page
    596
    •HR 3200 IH
    1 ‘‘(ii) APPLICABLE PER INSTANCE
    2 AMOUNT.—In this subparagraph, the term
    3 ‘applicable per instance amount’ means—
    4 ‘‘(I) in the case where the defi5
    ciency is found to be a direct proxi6
    mate cause of death of a resident of
    7 the facility, an amount not to exceed
    8 $100,000;
    9 ‘‘(II) in each case of a deficiency
    10 where the facility is cited for actual
    11 harm or immediate jeopardy, an
    12 amount not less than $3,050 and not
    13 more than $25,000; and
    14 ‘‘(III) in each case of any other
    15 deficiency, an amount not less than
    16 $250 and not to exceed $3,050.
    17 ‘‘(iii) APPLICABLE PER DAY
    18 AMOUNT.—In this subparagraph, the term
    19 ‘applicable per day amount’ means—
    20 ‘‘(I) in each case of a deficiency
    21 where the facility is cited for actual
    22 harm or immediate jeopardy, an
    23 amount not less than $3,050 and not
    24 more than $25,000; and
    VerDate Nov
    There are many more prior to this page.

  41. Has anyone on this blog read the 1017 page bill? Since there seems to be some confusion perhaps the people that drafted the bill should be summoned before the House and under oath have the entire bill explained no matter how long it takes.

  42. After 40 yrs. in medical practice one fact is very clear. The more government and insurance interference in medical practice the more it costs. If we had the money being spent on medical care for actual medical care there would be no problem. Rest assured HR 3200 will increase these administrative costs much more and we will pay more and get less actual care. Then we will have higher taxes and longer waits. I know one thing for sure about the citizens of the USA and that is they do not like waiting on needed medical care.

  43. Barry Carol raises a couple of important issues: availability of Medicaid providers and compliance with IRS reporting rules.
    Both his concerns are valid, but both are even bigger concerns under HR 3200.
    I agree with Barry that any expansion of Medicaid (or, as I proposed, a safety net program tied to Medicaid) may result in a shortage of some types of providers willing to accept low-income patients. However, this is going to be a problem with any expansion of coverage—Medicaid or any other. As an example, we have too few primary care providers. HR 3200’s proposed Medicaid expansion plus subsidized access to insurance exchange coverage is going to encounter the same problem of resource availability. In either case, we have the choice of loosening professional training standards for certain kinds of care or waiting until demand drives up provider prices to a point at which supply starts to grow.
    I also agree with Barry that inevitably there will be those who try to subvert the system—even it is tied to federal tax collection. However, there are very few of us who do not have to file tax returns, and if coverage and premium choice are part of this process, and tied to the regular withholding schedule, this is likely to be far more effective than HR 3200’s after-the-fact gotcha penalty provisions. And, as we all know, failing to file is regarded by the IRS as VERY, VERY BAD (and expensive to the non-filer).

  44. I tend to read a lot of ‘advice’ about health care reform from people who became millionaires out of our current system.
    I take that advice with a grain of salt. I suspect they are also the folks with enough $$$ to have lobbyists.
    Here’s to hoping the Democrats can actually take a little out of the necks of these folks.

  45. Roger,
    Unless this bill removes the illegality of individuals obtaining their own private policies, this bill will be dead. Healthcare reform will not happen if you have the president insinuating, and rightly so, that in his plan, patients older than 65 will often be deprived of medical treatments needed to extend their lives and perhaps intensive medical care altogether. This will be his waterloo as some republican wonk has noted……..
    Sad to say, but he picked the wrong $h!thole to investigate.
    -Steve
    http://www.thegenesherpa.blogspot.com

  46. Unless acute care hospitalization physician fees are limited by bundling (“physician DRG”)Medicare costs will continue to skyrocket as multiple consultants continue to bill every day during the hospitalization and can legally do so as long as documentation for sevice is provided. How about tort reform and the trial lawyers sharing in the sacrifice? Not a chance as long as they keep the money flowing to Congress!

  47. Don’t forget that Obama called it “health insurance reform” on Wednesday. That’s far different than “health care reform”. It sets the bar much lower, but did you expect anything different from Washington?

  48. Hey listen if the insurance companies make money let them. If you can’t get healthcare then you should die and so should your family. If you make money doing what ever it is that you do then we should let you. You take care of yours I take care of mine simple.
    If you believe in Jesus you will be fine either way.
    NO HEALTH CARE REFORM!!!

  49. Maybe I am being too naive, but I do not know why it is so hard for President Obama to understand that our Healthcare system in the United States just needs tweaking. If clear directives are delineated by the President to health insurance carriers, pharmaceutical companies, hospitals and doctors to promote fairness with charges, I believe all people in the United States would benefit. Am I being naive?

  50. In order to “reform” health care processes, it requires an understanding of the macro-economics of why reform is needed. The perversions of the current iteration of healthcare has its genesis in the defacto decades of wage controls on doctors.
    Think back to the cause of the inflation of the 1970s. It was the wage and price freeze enacted by the infamous President Nixon.
    This is the cause of inflation embodied in excessive utilization, today, despite the myriad of other plausible explanations beginning with litigation protection.
    Doctors are not paid to practice cost effective medicine. They practice in reaction to the controls put upon them by the government, health insurance companies, PBMs, and hospital administrators, all of whom are gaming the system to suit their own interests.
    There are things that doctors perform now as they did in 1990. They are getting paid 30 cents on the 1990 dollar excluding inflation.
    To accomplish the goal of achieving accountable cost effective medicine, doctors must be paid to do that. Since doctors control how each dollar is spent (they only make a small percentage of that), it would be rather simple to pay each to establish a fixed amount of savings. If each doctor in is/her judgment conserved a small amount in overall expenditures, say $100,000, that would equate to about $70 billion per year, more than enough to “pay” for the reform.
    However, doctors would need to share in the savings.
    As a simple example, a surgeon does one less exploratory lap or elective gall bladder per year. The surgeon is out a few hundred bucks but the savings to the system is the entire hospital fee, home care, and more. If there is a complication avoided by not having done the “elective” operation, the savings could be tens of thousands. Of those thousands saved from not having the hospital expense, the surgeon should be paid a certain percentage more than the fee paid had the surgery been done.
    As has been done in agriculture (interestingly enough) when farmers were paid not to plant a certain amount of acreage, physicians should be paid not to abuse the system or putting it another way, be paid to save the entire system big bucks.
    That may be too simple for a Congress that takes pleasure in complex carrot and stick games, the kind that got us into this mess. That is how the Bill is resurrected.

  51. Medicare and Medicaid payments should be divorced from the government completely, not just given to a different set of non-elected officials. M/M should act purely as a benefits coordinator, collecting and subsidizing premiums from those respective populations, and maintaining it’s own risk pools, then let private insurers bid to administer those programs. This is the way many large businesses operate, and has been very successful. This would wipe out cost shifting by providers, lowering premiums for everybody. In this way, private insurers never touch the M/M trust funds and would have no incentive to deny coverage or cherry pick patients from the elderly, poor and worst case patients. Then you give more freedom for high deductible HSAs, which would force people to make smarter decisions about what doctor to see and what procedures to have.

  52. I think it’s very hard for some to grasp the real importance of this health care reform. The question is really how do we solve this health care crisis? It seems that no matter what approach we take; that approach will not be good enough for some people to accept. I rather see everybody get health care. Out of all the money the government spends (and wastes), health care is mainly the one I have no gripes about. You never know what can happen to you or your love ones. If we approach about reforming health care by plan A then people will b—h and gripe. If we approach health care reform with plan B or C, then the same old gripes. We need to suck this one up and ensure health care is for everybody.

  53. Roger – I see at least two problems. First, Medicaid pays so poorly that it will be hard for policyholders to find doctors and other providers willing to accept them as patients. Second, many millions of people are either not subject to withholding at all because they are self-employed or paid off the books or they derive a significant percentage of their income from tips. For those with income that doesn’t show up on a W-2 form or a 1099-INT or 1099-DIV, it’s extremely easy to hide. While the IRS is quite good at matching income reported on documents to social security numbers, it is not very good at finding hidden income. Those of us who work for traditional employers and have all of our income reported on the appropriate documents will feel even more like chumps than we do already.

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