A friend of mine sent me an email with an interesting Twitter feed, from a guy (fleckman) who had perused the new “Obamacare” Health Care Bill. It should be noted that this is not the final bill coming before a vote in the House, but is probably the most likely to form the mold upon which the final bill will be cast.
I see he has expanded upon his tweeter feed to include the last couple hundred or so pages of the bill. The email I got was only good up to page 500. Still, this post seemed long enough . . .
Now, I don’t want to give too much credence to this Fleckman. But he obviously spent a lot of time reading the bill and coming up with his, ahem, “interpretation”, and I appreciate that. Plus, it gives a very handy outline of all the myths, misinformation, and downright lies which will be spread about the bill. (Some of it reads like he copy and paste sound bites from the newest Gingrich primer.) So hopefully when somebody starts talking about all the rotten things this bill is going to do, you’ll be able to give them a factual account of its actual verbiage.
Please note that this is not a compilation of articles written in support of the bill; rather responses were given by actually reading the portions of the bill he addresses.
Finally, I don’t want to imply that I feel this is a perfect bill. I don’t. But it’s a good compromise between single-payer and individual plans which will allow universal coverage. And it’s leaps and bounds over that status quo. If people don’t like this method to universal coverage, then fine. But I can’t stand by and let it be defeated by blanket propaganda and irrelevant claims based upon scare tactics or hot-button issues completely unrelated to the topic.
Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure!!
The government is not proposing to “audit books”. They will examine the “financial solvency and capital reserve levels of employers that self-insure by employer size.” This information is already provided to the government (the IRS and SEC). The purpose of this examination is to complete a report looking into the ability of self-insured companies to meet the obligations they assign themselves by being self-insured. This report is to be submitted “not later than 18 months after the date of the enactment of this Act.” The above statement implies that the government will be conducting additional accounting oversight, and on a long-term scale, neither of which is accurate.
Pg 30 Sec 123 of HC bill – THERE WILL BE A GOVT COMMITTEE that decides what treatments/benes u get
The government committee will not decide what treatment or benefits you get. The panel, which is mandated to represent both the medical field and employers, will recommend (i.e. not mandate) two things: an “essential benefits package” (that is, minimum coverage), and cost-sharing levels for “enhanced plans and premium plans” (which would ensure a maximum individual medical expense). Not only would this committee not mandate the coverages in those plans, it would not mandate which plan is offered or which plan a person must buy. This in no way effects choice of the individual, only attempts to ensure standards under which an individual is guaranteed a certain level of care.
Pg 29 lines 4-16 in the HC bill – YOUR HEALTHCARE IS RATIONED!!!
Page 29 deals with cost-sharing. This does not ration healthcare, it sets maximums for the amount an individual has to pay for medical under an insurance plan ($5000 for an individual and $10,000 for a family, with automatic increases based upon increases in the Consumer Price Index). Either this guy doesn’t know what cost-sharing is, or he is being intentionally misrepresentative.
Pg 42 of HC Bill – The Health Choices Commissioner will choose UR HC Benefits 4 you. U have no choice!
Commission sets standards for minimum coverage. It does not mandate specific coverage.
PG 50 Section 152 in HC bill – HC will be provided 2 ALL non US citizens, illegal or otherwise
Talk about grasping at straws. Here’s the exact verbiage of the text: “Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related service.” Oh my God! Those evil bastards!!
Pg 58HC Bill – Govt will have real-time access 2 individuals’ finances & a National ID Healthcard will be issued!
This says nothing about access to an individual’s finances, it’s an individual’s “financial responsibility at the point of service.” Not even close to the same thing. Obviously disingenuous here. It does not mandate a national ID health card, but “may include utilization of a machine-readable health plan beneficiary identification card”, which is already provided by most insurers. Nowhere does it say that these cards would stop being issued by the insurer and begin being issued by the government. (Talk about paranoid.)
Pg 59 HC Bill lines 21-24 Govt will have direct access 2 ur banks accts 4 elect. funds transfer
This does state the desire to enable EFT’s “to allow automated reconciliation with the related health care payment and remittance advice.” However, it does not stipulate the government’s access to bank accounts, and EFT’s would not be required. There’s a difference between “enable” and “allow” and “required.” The wording seems to imply a vehicle to allow people to pay via EFT, which most people are all to happy to do online with a variety of vendors.
PG 65 Sec 164 is a payoff subsidized plan 4 retirees and their families in Unions & community orgs (ACORN).
Section 164 is a temporary subsidized reimbursement plan to help off-set costs of insuring retirees who participated in employment-based insurance plans, which would include any plan “maintained by one or more employers, former employers, or employee associations, or a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan.” Technically he’s right that it will help people in unions and community organizations, though it will also pay money to employers who do not hire union workers. Obviously, the purpose of his line was to prey on the negative connotations some people have of unions or ACORN, specifically, even though the language is not targeted towards these groups.
Pg 72 Lines 8-14 Govt is creating an HC Exchange 2 bring priv HC plans under Govt control.
This will create a health care exchange, and would include a public health insurance option. You can debate the merits of such a policy, but that’s a far cry from bringing private health care plans under government control.
PG 84 Sec 203 HC bill – Govt mandates ALL benefit pkgs 4 priv. HC plans in the Exchange
This says nothing about mandating benefits packages in the health care exchange. It merely states that in order to be in the exchange, an insurer must offer a basic plan in the exchange. In order to offer an enhanced plan, an insurer must offer a basic plan, and in order to offer a premium plan, an insurer must offer an enhanced plan. This increases a consumer’s choice by ensuring there are less expensive basic plans a person can buy, instead of being forced into a higher priced plan at the sole discretion of the insurance company.
PG 85 Line 7 HC Bill – Specs for of Benefit Levels for Plans = The Govt will ration ur Healthcare!
Standards within the plans will be mandated, meaning a guaranteed minimum level of coverage. However, standards do not limit the amount of insurance above these minimums which a company may offer. So if you wish to purchase more insurance than the standards offered, you would still have that option. This is the exact opposite of rationing.
PG 91 Lines 4-7 HC Bill – Govt mandates linguistic approp svcs. Example – Translation 4 illegal aliens
A more appropriate example – translation for legal residents. I guess the theory is that if you don’t speak English you don’t deserve adequate health care. The author is using the “illegal immigrant” debate to scare people away from a completely unrelated topic. Common, but no less inappropriate or bigoted.
Pg 95 HC Bill Lines 8-18 The Govt will use groups i.e., ACORN & Americorps 2 sign up indiv. for Govt HC plan
This section does stipulate the use of outreach programs to educate “vulnerable populations” about health care options. While, in theory, this could include groups such as ACORN, he’s again obviously using a completely unrelated hot-button topic to evade the health care issue. Besides, why is it so bad that “vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments” be educated about this health care? I guess if a quadriplegic with a learning disability doesn’t take the initiative to learn the finer points about the program then that’s his concern.
PG 85 Line 7 HC Bill – Specs of Ben Levels 4 Plans. #AARP members – U Health care WILL b rationed
He already mentioned this three examples ago . . . not sure why he brought it up again.
-PG 102 Lines 12-18 HC Bill – Medicaid Eligible Indiv. will b automat.enrolled in Medicaid. No choice
The exact wording is: “an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan (emphasis added) is automatically enrolled under Medicaid.” So there is a choice. Unless, of course, the choice is whether or not to be insured.
pg 124 lines 24-25 HC No company can sue GOVT on price fixing. No “judicial review” against Govt Monop
There is no judicial review for premiums or pay rates established for the public health insurance plan. Technically, the above statement would be correct, if one assumes that the government is going to set up a public plan with the sole intention of losing enough money to drive private insurance companies out of business.
pg 127 Lines 1-16 HC Bill – Doctors/ #AMA – The Govt will tell YOU what u can make.
This is incredibly misleading. The bill sets up payment terms for physicians under the public insurance plan, based upon whether they are preferred, participating, or other providers. That’s what insurance companies currently do. The government is not telling physicians what they can make any more than State Farm or Blue Cross currently does.
Pg 145 Line 15-17 An Employer MUST auto enroll employees into pub opt plan. NO CHOICE
The auto-enrollement actually specifically legislates the choice of the employee to determine what plan they may enroll in. The auto-enrollement is not designed to automatically enroll an employee into the public plan, but rather to enroll an employee into an insurance plan, specifically, “the plan option with the lowest applicable employee premium.” This does not predicate enrollment into the public plan at all. Further, the employee has an option to opt-out of automatic enrollment if they chose to enroll in another, more expensive employer plan or another plan not offered by the employer. The employer must, by law, accept this opt-out and “under no circumstances” may automatically enroll the employee.
It should be noted that in cases where an employee is currently forced to enroll in a specific insurance plan as a condition of employment, this will actually increase the employee’s choice. At any rate, it will not decrease the choice of another employee at all, unless (again) it is the choice of the employee to simply not have health insurance.
Pg 126 Lines 22-25 Employers MUST pay 4 HC 4 part time employees AND their families.
This is actually on page 146. This is accurate that the employer must provide health coverage for part time employees as well as full-time employees. However, the employer is allowed to pro-rate the coverage for the employee based upon the difference between the hours they work and the hours of a full-time employee. And as the purpose of the bill is to mandate universal coverage, this should not be surprising.
Pg 149 Lines 16-24 ANY Emplyr w payroll 400k & above who does not prov. pub opt. pays 8% tax on all payroll
This is disingenuous. The 8% tax is required of any employer who does not offer insurance coverage. While this includes the public plan, the statement makes it sound like an employer will be subject to this fine if they offer private insurance but not the public option. This is a false statement.
pg 150 Lines 9-13 Biz w payroll btw 251k & 400k who doesnt prov. pub. opt pays 2-6% tax on all payroll
This is the same as the above argument. The bill allows for small employers to pay a smaller tax for not offering health insurance than larger ones. But, again, this only pertains if they do not offer any coverage. If they offer private insurance coverage they will be exempt from this tax, even if they do not provide the public option plan.
Pg 167 Lines 18-23 ANY individual who doesnt have acceptable HC accrdng 2 Govt will be taxed 2.5% of inc
It is true that an additional tax will be levied on an individual for not having any health care coverage, as part of Congress’s decision that coverage be a shared responsibility between the government, the employer, and the individual. However, it is not true that this tax will be levied against every individual. There are exemptions. In fact, in direct contrast to the above statement, he identifies one below:
Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from indiv. taxes. (Americans will pay)
Nonresident aliens are already exempted from most taxes, including Social Security taxes, as they are generally not eligible for US Government services. And the taxes that are levied are only for certain incomes. Furthermore, many nonresident aliens don’t even preside in the United States, making it absurd that they should pay for services they won’t receive. However, this isn’t really a fairness issue; this is a tax policy issue which extends far beyond the subject at hand.
Pg 195 HC Bill -officers & employees of HC Admin (GOVT) will have access 2 ALL Americans finan/pers recs
This is not universal access. It only applies to certain information (which is already provided to the IRS) which can be used to determine if a person is financially capable of paying for insurance. And it’s not available for “all” Americans, only those whom have filed taxes. This is so that people who cannot afford insurance are not subjected to the, we’ll call it, “punishment tax”.
PG 203 Line 14-15 HC – “The tax imposed under this section shall not be treated as tax” Yes, it says that
It actually says: “The tax imposed under this section shall not be treated as a tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.” Mildly amusing, but not absurd.
Pg 239 Line 14-24 HC Bill Govt will reduce physician svcs 4 Medicaid. Seniors, low income, poor affected
This does not reduce anything. This refers to the Social Security Act, and changes limitation already present from being effected under a target growth rate computation to a physician fee schedule. In other words, it merely changes the calculation used to determine certain limitations.
Pg 241 Line 6-8 HC Bill – Doctors, doesnt matter what specialty u have, you’ll all be paid the same
That’s not exactly true. This establishes (or changes) conversion factors based upon service categories. While it is accurate that these changes apply “without regard to the specialty of the physician furnishing the service,” certain service categories are going to apply either in whole or in general to certain specialties. For example, though it would be technically accurate that conversion factors for treatment of cancer would be the same whether you’re a podiatrist or oncologist, there’s not really a very high likelihood of you getting treated for cancer by a podiatrist. Unless, of course, it’s foot cancer. But in that case, I think it’s fair that the podiatrist should be paid for treating your foot cancer the same as the oncologist would have. **note – this only applies to Social Security benefits (i.e. Medicaid or Medicare)
PG 253 Line 10-18 Govt sets value of Dr’s time, prof judg, etc. Literally value of humans.
This applies to payment schedules of doctors providing Social Security benefits. Remember what I said about State Farm and Blue Cross dictating doctor’s pay? The same is applicable here.
PG 265 Sec 1131Govt mandates & controls productivity for private HC industries
Which do not already incorporate such improvements. If you read the section, it’s a list of amendments to the Social Security law. Most of the amendments seem to be regarding dates certain things take effect.
PG 268 Sec 1141 Fed Govt regulates rental & purchase of power driven wheelchairs
This is another amendment to the Social Security law. It actually doesn’t change any regulation, just changes the verbiage from “power-driven wheelchair” to “complex rehabilitative power-driven wheel-chair recognized by the Secretary as classified within group 3 or higher.” Those liberal bastards!!!
PG 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!
I don’t think he actually read this section. All this section does is set up a study to determine how much ambulance rides cost to the hospital. Then, if it costs a certain hospital more money to send out an ambulance, then the government will increase Social Security payments to that hospital. So far from “rationing” services, it actually would help ensure that hospitals are not losing money on ambulance rides for cancer patients covered under Social Security. Which actually sounds like the exact opposite of rationing.
Page 280 Sec 1151 The Govt will penalize hospitals 4 what Govt deems preventable readmissions.
I don’t understand this guy. First he complains that the government wants to ration health care, then he complains when the government wants to ensure that people don’t go home from the hospital before they are supposed to. Which is it, dude?
Pg 298 Lines 9-11 Drs, treat a patient during initial admiss that results in a readmiss-Govt will penalize u.
How dare the government expect doctors to appropriately diagnose a patient? The nerve!! This is not a penalty for when a doctor admits a patient and then they have to be readmitted. This is a penalty when the originally admission is so errored that it results in a second medical problem required readmission.
Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Govt tells Drs. what/how much they can own.
What this section does is stipulate that referrals made by a doctor receiving Social Security payments to him or herself can not be used to increase any ownership in their hospital. This seems to be a technique to stop a doctor from using self-referrals to increase his bill to Medicaid more than it would have been if he would have just preformed the procedure he referred himself to do.
Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion- Govt is mandating hospitals cannot expand
The government is not prohibiting hospitals from expanding. As I explained above, it is forbidding that doctors refer patients to themselves and use the extra money to expand hospitals. It’s prohibiting doctors from ripping off the government.
pg 321 2-13 Hospitals have oppt to apply for exception BUT community input required. Can u say ACORN?!!
This provides for an exception to the above prohibition, provided the community supports the expansion. He’s just looking for a tie-in to ACORN – jingling keys over here to take your attention off the subject over there.
Pg335 L 16-25 Pg 336-339 – Govt mandates estab. of outcome based measures. HC the way they want. Rationing
What are some of the outcome based measures, you might ask? Rates of admission and readmission to a hospital, measures of prevention quality, mortality following surgeries, health functioning and survival for patients with chronic diseases, and measures of patient safety. These measures are used to ensure that patients are getting adequate care to eliminate future complications while avoiding potentially dangerous care. Insurance companies do this all the time. And, again, this only applies to Social Security patients, which is a form of insurance.
Pg 341 Lines 3-9 Govt has authority 2 disqual Medicare Adv Plans, HMOs, etc. Forcing peeps in2 Govt plan
So, what the author is saying is that the government is trying to force people out of a federally subsidized plan so they are forced into a federally funded plan. Okay, then. At any rate, it doesn’t say anything about HMO’s. Though it does disqualify Medicare Advantage plans which, you know, don’t work.
Pg 354 Sec 1177 – Govt will RESTRICT enrollment of Special needs ppl! WTF. My sis has down syndrome!!
This section does not restrict anything. What it actually does is change the date of the Social Security law restricting certain enrollments from January 1, 2011 to January 1, 2013, or to January 1, 2016 for certain plans. Plus, it grandfathers certain people in. So it’s doing the opposite of restricting coverage – it’s increasing coverage times for special needs. Your sister is safe.
Pg 379 Sec 1191 Govt creates more bureaucracy – Telehealth Advisory Cmtte. Can u say HC by phone?
Well, this section does create a Telehealth Advisory Committee, so I guess it’s hard to argue with the “creates more bureaucracy” statement. But the committee doesn’t actually establish a telehealth program. It merely exists to recommend policy regarding telehealth practices. Telehealth already exists and is run by private industries.
PG 425 Lines 4-12 Govt mandates Advance Care Planning Consult. Think Senior Citizens end of life
This amends Social Security law to pay for advanced care planning consultations. Which is technically what he says. But his implication is clear – this will set up a system whereby the government decides what appropriate advanced care and end of life options are. This is not even remotely accurate. It only pays for services already available but currently not paid for. And these services won’t be provided by the government, anyway.
Pg 425 Lines 17-19 Govt will instruct & consult regarding living wills, durable powers of atty. Mandatory!
Completely false. The government will not instruct and/or consult regarding living wills and powers of attorney. Social Security will merely pay for these services. And these services are not mandatory. Social Security payment for them if the patient desires them is. There’s no way anybody who read this section could possibly come the the conclusion that the government will force government-provided consultations on people. Not even by mistake. He’s arguing for choice by arguing against it.
PG 425 Lines 22-25, 426 Lines 1-3 Govt provides apprvd list of end of life resources, guiding u in death
The “end of life resources” are not government approved; they are national and State-specific. Big difference (as in, not even close to the same thing). The practitioner has to give a list of resources which may further aid the patient; there’s no government “death guiding” involved here. Again, arguing for choice by arguing against it.
PG 427 Lines 15-24 Govt mandates program 4 orders 4 end of life. The Govt has a say in how ur life ends
This is an especially ironic statement, because this particular piece of the legislation says that Social Security will only pay for advanced care or end of life consolations which include “a program for life sustaining treatments.” So it’s really saying that the government should not have any say in how early your life ends. The specific lines he addresses are a prequel to standards of such “life sustaining treatments,” which are virtually entirely left to the States to decide. It does not force such life sustaining treatments on the patient, only forces their availability.
Pg 429 Lines 1-9 An “adv. care planning consult” will b used frequently as patients health deteriorates
Again, Social Security will pay for them. They are not required.
PG 429 Lines 10-12 “adv. care consultation” may incl an ORDER 4 end of life plans. AN ORDER from GOV
Again, the order is not from the government. It’s an order from the patient. The government merely pays for the consultation to legally formulate the order. The government does not conduct the consultation, and does not require it.
Pg 429 Lines 13-25 – The govt will specify which Doctors can write an end of life order.
This is a definition, not a limitation. It does not specify which doctors can write an end of life order, only that doctors must write an end of life order. If that is not possible, certain other health practitioners, also defined in the section, may do so.
PG 430 Lines 11-15 The Govt will decide what level of treatment u will have at end of life
This does not stipulate what kind of treatment will be delivered, but (again) rather stipulates that Social Security will pay for a consultation as to what kind of treatment will be delivered.
Pg 469 – Community Based Home Medical Services=Non profit orgs. Hello, ACORN Medical Svcs here!!?
So, every time the word “community” is mentioned we have to hear about ACORN? What a weak argument.
Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. 1 monthly payment 2 a community-based org. Like ACORN?
PG 489 Sec 1308 The Govt will cover Marriage & Family therapy. Which means they will insert Govt in2 ur marriage
Having the government pay for marriage and family counseling doesn’t mean anything other than people will be able to have coverage for marriage and family counseling. Why is this a bad thing? I thought the Republicans were supposed to be the ‘family party’, anyway? They think the government can step in and say who can or cannot get married, but the government has no role in helping pay for services which might preserve marriage?
Pg 494-498 Govt will cover Mental Health Svcs including defining, creating, rationing those svcs
These pages actually sate that the government will pay for mental health counselor services and treatment. In then defines whom an appropriate mental health counselor is (needs a masters or above, at least two years of supervised practice, and a State license or certification). It doesn’t actually define the services, offers no guidance on creation of these services, nor does it place any limitations on the payment of those services, other than the fact that the services have to be performed in accordance with State law.