Health Care Reform HR 3962

The views expressed in this blog are my own personal opinions and do not represent the views of Cottonwood nor it's administration.

As everyone knows by now HR 3962, the health care reform bill, passed in the House of Representatives by a vote of 220-215. Our own representative in Congress, Gabrielle Giffords, voted in favor of the bill. I have previously outlined my concerns about this version of health care reform, indicating that it goes beyond health care reform and is essentially a government takeover of the entire health care system. I don't have anything new to say except that while the initial version HR 3200 was 1300 pages long HR 3962 is 1900. I will next comment on this issue after the final version is complete after coordination and merger with the Senate version which we have yet to see.

There is a lot that will be said by many on this bill that is based upon rumor.. I won't comment on it until I have read the final version in it's entirety just as I did HR 3200 so it will be awhile. I read the previous version while my wife was out of town and I had plenty of time on my hands!

Thought for the day

Give thanks to the Lord for He is good. His mercy endures forever.

HR 3200 Health Care Reform part 4

I have been writing recently about the House proposed health care reform bill HR 3200 and why I think it is a bad way to go about reform. I do want to comment today about two different topics, that of the so called "death panels" as well as some of the positive aspects of the bill.

First of all there are no "death panels".  Pages 424-434 do  cover advance care planning consultations. I have read this section a number of times and I can see there are two areas that I believe have led to the concerns. One is the requirement for there to be a consultation between the patient and the doctor at minimum every five years regarding advance care planning. The bill outlines what must be included in this consultation.There are a number of things but I think the areas of concern are "An explanation by the practicioner of the continuum of end-of-life services and supports available" and the "reasons why the development of such an order (regarding life sustaining treatment) is beneficial to the individual and the individual's family". This coupled with  a requirement for there to be developed quality measures on end of life care and the monitoring of physician's adherence to these quality measures (page 432)  can lead one to conclude that there could be external pressure imposed by the government to try to limit life sustaining treatments. I have to say that this is worded vaguely enough that it may be possible that that is exactly what is intended. I say this partly because of the great costs of end of life care to Medicare which I will discuss in another blog. But there are no "death panels" per se.

Secondly the latter half of the bill includes a great deal which I hope can be incorporated into any health care reform bill and those are incentives to increase the number of people going into primary care specialties and the Public Health Corp along with scholarships for disadvanteged students, prevention and wellness services grants, school based health clinics and increased incentives to make it easier and more attractive to get into nursing.

I will discuss later more about end-of-life services and how this is an issue that we can't just hope will go away.

Thought for the day

" How good it is to sing praises to God for He is gracious and a song of praise is fitting"

The psalmist

HR 3200 Health Care Reform part 3

The views expressed in this blog are my own personal views and do not reflect the views of Cottonwood nor it's administration.

Well, I finally did it! I finished reading HR 3200 "America's Affordable Health Choices Act of 2009" which is the current House version of health care reform, all 1017 pages of it. I have to admit though that I skimmed sections relating to health care in Puerto Rico and a vast array of nursing home regulations. I did this because there is a great deal of controversy regarding health care reform, what it entails, what it means etc. and I like to get my facts straight before spouting off my own opinions on this bill. I wish President Obama would do the same as he continues to tell us that if we like our health plans and our doctors we don't need to change them when HR 3200 clearly indicates otherwise.

As I mentioned before the current biggest controversy is over whether or not a health care reform bill would include a "public plan option", a government sponsored Medicare like program available to all Americans regardless of age or economic status. Those of you who have followed this blog know that I am not in favor of such a plan but that is not the problem I have with HR 3200. While I am not in favor of a public plan there are many good arguments for it as well as my arguments against it and I have to admit that my arguments may be faulty. But HR 3200 does not propose simply a public plan option but proposes a complete takover of the health care system in the United States, full governmental control of what now is a public -private enterprise. For those who think this statement sounds too dramatic I invite you to read the bill yourself.

HR 3200 proposes a brand new independent government agency the Health Choices Administration headed by a Health Choices Commissioner with broad powers. The name of the agency as health choices is very Orwellian as the purpose of the agency is to ensure that we have no choices regarding health care. The Commissioner has broad powers that include:

establishing limitations on individual health insurance coverage (page 18)
establishing premium rates (page 21)
the right to full access of all financial records of any company that wants to self insure (page22)
make sure that no law can provide any incentives for a company to self insure (page 22, 23)
setting the standards for all provider networks (page 24)
determining what benefits will be covered in all basic and enhanced plans (page 30 -37)
establishes standards for coordination of benefits and reimbursements (page 40)
decides what qualifies as a "Qualified Health Benefit Plan" to which all plans must meet within 5 years of    enactment of the law (page 17)
prohibits enrollment of any new individual to any currently existing plans (page 16)
operates a "health insurance exchange" by which the government takes control of any new private plans (page  72 )
defines all terms used in health insurance coverage (page 45)
has access to individual's bank accounts to enable "real time determination" of an individual's financial responsibility (page 58)
issues a machine readable health id card that must be used before it can be determined what services you may or may not qualify for (page 58)
cancels all state mandated benefits unless the state reimburses the federal government for the increased costs (page 87)
decides which benefits any qualified plan may provide for any given service area (page 84)
imposes an 8 % payroll tax on all employers who do not offer health care coverage (page 149-150)
requires employers to provide health care coverage for part time employees (page 145-146)
taxes any individual without health care coverage (page 167)

I will discuss later some of the implications of these in regard to our freedoms and choices in health care.

Thought for the day

Universal access and coverage, yes! HR 3200 no.

HR 3200 Health Care Reform part 2

The views expressed in this blog are my own personal opinions and do not represent Cottonwood nor it's administration.

I indicated before that I would discuss further HR 3200 the House version of health care reform, " America's Affordable Health Choices Act of 2009". I know I keep on talking about various aspects of health care reform but it is an issue that will affect us all greatly.

Currently the main controversy is over whether health care reform will include a "public option" in which the Federal government would compete directly with private insurers in a plan that would be available to all of any age and regardless of income status. While I am in general opposed to a public plan option there are ways in which it could be done that I can live with but HR 3200 goes way beyond just a public plan option. I mentioned before that it represents a possible complete goverment takeover of health care delivery in the United States. That is a pretty bold and striking statement and I need to back that up by directly examining HR 3200.

First of all HR 3200 proposes a new government agency, the Health Choices Administration. This agency would be an independent agency in the executive branch. (page 41)

The Health Choices Administration would be headed by A Health Choices Commisioner appointed by the president. (page 41)

The Health Choices Commisioner would have broad powers which I will outline in a separate blog. (pages 41-470

No new person can be enrolled in any currently existing health plan as of the date that the law is enacted (page 16) For us this means that no new Cottonwood employees would be permitted to enroll in our current existing plan.

Within 5 years all currently existing health plans must conform to all the requirements of the public plan option. (page 17)

Our current health care plan cannot change any terms or conditions without it voiding the plan. This includes coverage benefits, and co - pays. (page 16-17). For us this means that we will have to continue paying higher premiums as there can be no negotiating on any benefit modifications, co -pays, or deductibles. Cottonwood administration will have no ability whatesover to negotiate with United or any other insurer that does not meet all the same qualifications as the public plan option. Cottonwood will have no other financially responsible choice other than enroll us all in a plan that meets all Federal requirements for a "Qualified Health Benefits Plan". I will outline these qualifications in a separate blog. The bottom line here is that regardless of what the president says we will not be able to keep our current plan or our doctors as we have it now.

HR 3200 cancels all state mandated benefits unless the state pays the additional costs. (page 87)

There are other changes as well which I will outline in further blogs including what a "Qualified Health Benefits Plan" is and what powers the new Health Commisioner would have.

Thought for the day

One size does not fit all.

HR 3200 Health Care Reform

The views expressed in this blog are my own personal opinions and do not represent the views of Coottnwood nor it's administration

The controversy over the type of health care reform we will have appears to be heating up and it may take some time for a  cooperative consensus to take place. I wish that we all agreed on the idea of universal access and coverage for health care and could rationally discuss the many potential ways that we can work to achieve that goal but political discussion rarely is that way.

A lot of controversy surrounds the proposed House health care bill HR 3200, the "'American Affordable Health Care Choice Act of 2009". President Obama admitted that hasn't read it. I don't believe that many congressman or senators have taken the time to read it either. So I thought I would read it. All 1,017 pages of it! I tried. I really did try. I haven't given up yet and am still working on it but have only read to page 95. I don't know how many have read proposed bills before, but they are often very confusing, are in "legalese" that most of us do not understand easily. I have read a lot of proposed bills but they have all been on much smaller scale issues.Iin addition to it's length HR 3200 is extremely confusing and complex with definitions that are not explained at the time of the word's use and have to be found later in the document. I did spend a lot of time with this and plan on continuing to do so (My wife has been and is still out of town).

I do not think anyone who closely reads even 95 pages of this bill can come to any other conclusion than   this one: This bill  proposes a complete goverment takeover of the health care system: a complete takeover that would be fully accomplished within the next five years. Those of you who have been reading this blog know that for various reasons I have been oppossed to a universal public plan option. HR 3200, however, does not just propose a government sponsored Medicare like program but a government takeover of the whole health care system. In further blogs I will outline some of the proposals in this bill and will happily discuss this bill with anyone who really does interpret it differently than I do. And all I have read is just 95 pages.

Thought for the day

I would like to see this issue rationally discussed.

Health Care Reform, American Medical Association, Public Health Insurance Option

I read an article in the New York Times the other day that indicated the American Medical Association submitted comments to Congress in opposition to a public run insurance option for those who are non disabled and under 65 years of age. The public run insurance option is being strongly pushed by the Obama administration. I have previously discussed this option in my series on health care reform. This plan is essentially Medicare for everyone. While clearly needing reform, the public health insurance option has the potential of completely destroying the health care system we have now including the many parts of the system that do work. For this reason it is opposed by the American Medical Association which comments to the Senate Finance Committee.

Why is a public health insurance option a bad idea? It sounds at first look like a pretty good idea. After all, Medicare seems to work fairly well. The problem is though that Medicare works only because 70 % of patient care is provided under private insurance programs. Medicare payments are not enough to keep hospitals in business nor some medical practices, particularly psychiatric practices. While the Obama administration says it wants a publicly funded plan to keep private insurers fair and honest there are many other ways of doing this. Issues of preexisting conditions and excessive rates do need to be dealt with. A publicly funded plan will do more than keep private insurers honest and fair though. It will drive them out of business.

Another problem with this plan is the question of where the public funding will come from. Medicare is facing a financial crisis. To open up a similar plan to all Americans would come at an exorbitant cost, transferring many of the health care costs from private insurers to taxpayers. In regard to health care reform ideas the American Medical Association is right in my opinion to oppose any plan that includes an expansion of a public health insurance option.

Thought for the day

"All good gifts come from above"

St. James

Health Care Reform House Version

This will be my last in a series of discussion of health care reform for now. I will probably come back to this subject as the House and Senate pass their own versions of reform.

I am glad that many on the House Energy and Commerce Committee are considering some public-private joint ventures that would not dismantle those aspects of the health care system that do work. The House plan proposes that all Americans be required to carry health care insurance with government subsidies to help families making less than $88,000/year pay for the costs. The requirements would make employers, individuals, and the government all have responsibilities. The proposal would include greater consumer protections so that there will not be denials based upon pre existing conditions nor could insurers charge extraordinary rates. The House proposals are designed to minimize disruption by allowing people to keep their own existing health plans. The government would also create purchasing pools called "exchanges" to make private insurance coverage more affordable for individuals and small businesses.

One problem with the House proposals so far is the inclusion of a government plan that would compete with the private insurers. Like Senator Schumer's proposal this plan would have to be paid for by premiums rather than tax dollars. Reimbursement rates however could be low enough to drive the private insurers out of business and establish a government monopoly. As I indicated before a psychiatrist in private practice cannot maintain a business with current government rates through either the Medicare or Medicaid programs.

I appreciate any further comments on the various health care reform proposals.

Thought for the day

"Encourage the fainthearted, help the weak, be patient with everyone".

St. Paul

Health Care Reform

I want to continue talking about health care reform proposals. I again want to emphasize that the views expressed here are my own and not those of Cottonwood.

I am disappointed that the Obama administration is rushing health care reform without adequate input from doctors, hospitals, private insurers, and consumer groups. The plan is to get legislation signed by mid summer and I think this is way too fast. The Senate Finance Committee is meeting behind closed doors to consider four different plans none of which includes any possibility of public-private ventures. All the plans are a one size fits all which I think is unwise and may threaten those aspects of our current health care system that do work.

One proposal is the Medicare like plan that I previously talked about in which the government directly competes with private insurers which will after a time drive the private insurers out of business and leave us with a single payer system. Another proposal being considered is no public plan at all which I don't think is being seriously considered by anyone. Another plan would be to allow states to set up their own public plans. This at least gives some flexibility to allow changes and course corrections if things don't work well. The Arizona Medicaid AHCCCS program partially works, though doctors and hospitals can't survive if that is the only plan available. The Tennessee TennCare plan turned out to be a disaster and had to be drastically altered to keep the state from going bankrupt. But at least there was the opportunity for more local self correction.

The fourth plan being considered is a proposal by Senator Charles Schumer of New York. His idea is a Medicare like plan that would have to be paid for by premiums, not tax dollars. The public plan would have to follow the same rules as private insurers, maintaining a reserve fund to cover liabilities as well as having the same consumer protection rules with doctors and hospitals free to participate or not. This is as close to a private-public plan that is being considered and has some merit although it is very unlikely that in practice doctors or hospitals really would be able to not participate.

Overall I am disappointed that these are the only ideas being considered and do not think it is wise to rush to a decision with no real outside input.

Thought for the day

" If anything matters then everything matters".

W.M. Paul Young

Health Care Reform Proposals

As I indicated before I will spend some time over the next few days to review some of the proposals for health care reform that are being considered by the US Senate and the Obama administration. Again the opinions expressed here are my own and do not represent the opinions of Cottonwood.

One proposal being considered is that of eliminating the tax exempt status of health care benefits and discontinuing flexible spending accounts. Currently this tax exempt status is a tax break available only to those that have health insurance through employers and unavailable to those without health insurance. There is an anticipated savings of over 200 billion dollars per year on what essentially is a tax hike. But it also is essentially a "salary reduction" on those who have employer sponsored health insurance. These salary reductions do not affect the employers' bottom line as the changes really directly affect the worker. I don't really know what to make of this proposal. On the one hand the "haves" get more through health insurance tax breaks but this is also true for the tax break on home owner's interest payments and I don't think anyone would seriously considering eliminating that.

I am just not sure that a tax increase and effective salary reduction is a good idea in a time of recession. I would love to hear what other people think on this issue and really would like comments. Thanks.

Thought for the day

There are no easy answers.

Health Care Reform

I am back after having been gone to Dekalb, Illinois to see my oldest daughter graduate with her Master's degree in philosophy. It was a very fun trip and I enjoy spending time with her.

I want to talk a little bit about health care reform as that is currently being considered by the US Senate and the Obama administration. I will outline the various options that are being considered but today I just want to look at one of them, the idea of making a Medicare like program to all Americans. My views are my own and do not reflect the views of Cottonwood. This is my personal opinion.

Medicare has been a program that provides insurance coverage by the Federal government for all adults 65 or older. In many ways it as been a successful program but it is in financial difficulty now and there are proposed payment rate reductions to both health care providers and hospitals.

One problem I have had with the program all along is the lack of choice available to seniors. A person age 65 or older does not have to use Medicare. However if a patient wishes to go to a physician and pay out of pocket he or she is prevented from doing so as the doctor is not permitted to charge the patient outside the Medicare program if he or she sees any Medicare patients at all. So while I had my office practice no patient for confidentiality purposes could pay out of pocket or I would have run afoul of federal regulations with severe penalties. I had to bill Medicare. That is just not right. For psychiatric patients the reimbursement was only 50 % of the Medicare charge. I did see a number of geriatric patients but each one was a financial loss. If a Medicare like program was available to all Americans I do not see how a psychiatrist could maintain a private practice. Hospitals cannot survive on Medicare payments as well.

Another problem with this approach to health care reform is that because of lower government set rates the private insurers will be gradually driven out of business and the Medicare like program would then be the only insurer, restricting both patient choice and and resulting in restriction of services.

I hope that this approach to health care reform is not adopted.

Thought for the day

One size does not fit all.