Healthcare Reform, or National Disaster

Before we start on the actual HR 3200 bill itself, we need to define who it is that is not covered under any insurance plan, and how many there actually are. It all seems to depend on whom you listen to. According to the National Coalition on Health Care, who obviously has a dog in the fight, there are somewhere between 45 and 60 million Americans without coverage, and 90 million without continuous coverage for the full year. But according to the Congressional Budget Office, who is neutral in their assessments, that number is some 45 million, which will grow to 54 million by the time this legislation, if passed, will go into effect, with an additional 20 million who are on and off insurance plans within any given year. So let's use the 45 million, or 15% of the population, as a base number.

Who are these people? They tend to be the uneducated, poorer members of our population with the highest numbers existing in the Hispanic population. Only 4% of the uninsured population falls into the category of "uninsurable", roughly 1.8 million people or 0.6% of the population. But even a certain portion of those people declined to have coverage, citing expense as the reason. Expense is an overwhelming factor for most, some 97.5%, or 44 million, state that as the primary reason. But what about those who don't have health insurance because they simply don't believe in insurance, or have never had a need for it? 18.6%, 8.37 million people, of the total fall into those categories. And 2.4%, close to a million veterans, utilize the VA. Nearly all of the uninsured have access to public hospitals, community health centers, and local health departments, so they actually do receive medical treatment even though they aren't listed on any form of insurance rolls. Still others are eligible for Medicaid but don't apply simply because they don't know they're eligible, or are too proud to ask for the help. In census data I find that among those listed as uninsured are 9.7 million undocumented aliens, but if you include legal residents not yet citizens as well as undocumented aliens that number jumps to 43.8% of the uninsured population or just under 20 million. If we eliminate the number of undocumented aliens we can effectively reduce the number to 35 million uninsured, 11.5% of the population, and that's the number we should be talking about and using to assess costs, but we aren't. Or at least Congress and the White House aren't.

Among the major things I don't like about HR3200, aside from the bill itself, is the amount of companion bills associated with it, such as S 1343 which creates a national database from the separate state databases of our children in schools, and in the meantime create even more bureaucracies which require more employees and more funding. Since bills like S1343 are constantly added to other legislation, or passed in support of, there is nothing to keep more unnecessary legislation from being slipped in after the last reading of the legislation and just before the vote to ensure that it passes. When added to all the sub-departments and monitoring agencies created in HR3200, one has to wonder how we will pay for it all without raising taxes. Since government never creates wealth, only draws from the wealth of its citizens, isn't it time we demanded smaller government on the Federal level? Shouldn't we put our governance back into the hands of the states as the Bill of Rights set forth in the Tenth Amendment?

Included in the new agency positions that are created, complete with staff, are: Section 123, "Health Benefits Advisory Committee" (26 members); Section 141, "Health Choices Commissioner" ($191,300/yr, $172,200/yr for Deputy Commissioner); Section 144, "Health Benefits Plan Ombudsman"; and Section 201, "Health Insurance Exchange" (complete with trust fund). Most of the balance are sub-departments or agencies within departments that already exist, such as Health and Human Services, Social Security and Medicare. A few of these are: the Center for Comparative Effectiveness Research; the Agency for Healthcare Research and Quality; the Public Health Workforce Corps; the Advisory Committee on Health Workforce Evaluation and Assessment; the Task Force on Clinical Preventive Services; the Center for Quality Improvement; and the position of the Assistant Secretary for Health Information along with establishing a school-based health care program and a national medical device registry.

One other disparaging portion of this bill deals with an IRS tax penalty for NOT having insurance, as this bill mandates that everyone must acquire healthcare insurance. (So much for freedom of choice and free will.) That falls under Section 401, and changes the IRS Code to reflect a 2.5% tax liability, or "an amount not to exceed the applicable national average premium for such taxable year", for those who do not enroll in one form of health insurance or another. In other words, you have no choice in the matter except to enroll or pay a fine equal to a national average insurance premium for not enrolling, even if you live in an area where the rates are supposedly reduced by this law as the president promised in his speech before Congress. And the "national average premium" isn't based on what an individual would pay as part of a family or group, it's based on "self-only coverage under a basic plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins". This part is also a bit tricky in that the poor will have their premiums subsidized by increasing the premiums of those who can afford it. In addition, there is the very great possibility that many employees who are already under a plan would opt out in favor of joining the government plan, and having part of their premiums subsidized, in order to save money by reducing their costs. And who could blame them?

In looking at other questionable areas of this legislation, I found that the wording creating School-Based Health Clinics in Section 2511, besides being yet another bureaucratic agency, was severely lacking in clarity as to whom these clinics would be operated by, and I feel that's necessary since it is funded with grant monies. Also, it provides for access to our children's private medical records with the statement that the operators of the clinic "established and maintain collaborative relationships with other health care providers in the catchment area". Personally, I believe my child's health concerns are only the business of me, my child, and their doctor, not some outside agency. And I believe this opens the door for groups like "Planned Parenthood" to attempt to influence young teens in deciding on abortion or not. Again, that is something for the child, their parents and their doctor to decide as a family matter, not a public one.

In that same grouping of questionable issues comes Section 440 which essentially creates a Federal Child Protection Services, and adding yet another agency to monitor our state agencies by forcing each state to adhere to their rules regardless of how they were established and operate under state laws, and, again, all funded with our tax dollars in the form of grants. As I understand the wording of it, they can even override our state laws if they feel the state isn't doing the job they assign, not to mention the withholding of funding to the state to operate under their system. It all sounds a lot like they are circumventing the Tenth Amendment again and usurping states rights.

The last major problem I have with the legislation, other than its overall cost of implementation, is Section 1401, and the operational guidelines for the "Center for Comparative Effectiveness Research" and the "Comparative Effectiveness Research Commission" which is intended to oversee it. This is the part that contains the language often referred to as the "death panel" portion, but most of that has been removed since the first draft was presented on the floor of the House. While I think the "death panel" verbiage is a bit extreme, it does make one wonder. And I have to also ask why, if it was so innocuous, was any of it removed? This section defines early on that it is intended to "conduct, support, and synthesize research with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically." That statement alone certainly sounds like medicine by committee to me, and I don't want anyone but me, my family and my doctor to be making any decisions I haven't already made when it comes that time. And I get even more nervous when they throw in terms like "Decision Sciences" and "Economics" when it comes to my healthcare. But those are defining terms included in the goals and direction of both the "Center" and its governing committee.

We've been told that this "reform" won't cost us a dime, that it will save enough to pay for itself. But I certainly don't see that happening. I have yet, in all my years, to see a single government controlled program ever save us a single penny. Allow me to quote from the CBO report, "The tables included in the report summarize our preliminary assessment of the coverage provisions' budgetary effects and their likely impact on rates and sources of insurance coverage for the nonelderly population. According to that assessment, enacting those provisions by themselves would result in a net increase in federal budget deficits of $1.042 trillion over the 2010-2019 period. By 2019, CBO and the JCT staff estimate, the number of nonelderly people who are uninsured would be reduced by about 37 million, leaving about 17 million nonelderly residents uninsured (nearly half of whom would be unauthorized immigrants)."

There is only an estimated $170 billion in Medicare fraud, but from their own numbers I count some $800 billion in the creation of all these committees, centers and agencies, their operational and staff costs. Anyway you slice it, that's still $630 billion more than they can possibly save in that area. Even if they can force the insurance companies to reduce their premiums, that doesn't save the government any operational money, it only saves us in out of pocket costs. Then we must add in all the additional grants and funding that will come out of our tax dollars. I'd say a conservative estimate would be in the range of $1.3 trillion, and with typical cost overruns, as in any government project, we're looking at adding another $2 trillion to our National Deficit. To again quote from the CBO, "First, these figures do not address the entire bill. Second, the analysis was based on specifications that were provided by staff of the three committees and that differ in important ways from the 'discussion draft' version of legislative language that was released in June. The specifications that we analyzed are supposed to be reflected in the draft language released by the committees today, but we have not yet been able to analyze that language to determine whether it conforms to those specifications. Third, our analysis does not incorporate the administrative costs to the federal government of implementing the specified policies nor all of the proposal's likely effects on spending for other federal programs; we expect to include those effects in the near future, and we do not expect that they will have a sizable impact on our estimates." And where does this money come from? Tax dollars or more money borrowed from China, to whom we already owe an estimated $8 trillion.

The only portion that won't affect the deficit is that part which is pass through monies, such as the premiums paid, that are collected as revenues and issued as outlays to insurance companies under contract with the government to provide insurance to those now classified as uninsured. The CBO says in closing, "Finally, the budgetary information reflects many of the major cash flows that would affect the federal budget as a result of implementing the specified policies, and it provides our preliminary assessment of the proposal's net effects on the federal budget deficit. Some additional cash flows would appear in the budget-either as outlays and offsetting receipts or outlays and revenues-but would net to zero and thus would not affect the deficit." Again, that statement is about what the insurance companies, for one, would get as pass through dollars, not what the overall costs of implementation would be. So when the President stated that this legislation wouldn't cost us anything, I'm certain he was only referring to the final portion of the assessment and that portion of the legislation.

Since it is obvious that Medicare and Medicaid would be adding most of the uninsured to their rolls, and adding the costs to an already overburdened system, to say that Medicare won't be affected by it is very misleading. In fact, some of the initial startup costs for this program will be "borrowed" from Medicare (approximately $498 billion) which is estimated to be in default by 2017 as it stands now. Congress has "borrowed" from Social Security since 1953 and from Medicare since 1978 and has yet to repay a penny of it. So how is it that we are to believe that they will repay any money they "borrow" now?

Regarding some of the additional legislation which may be added to this bill, or passed in support of, is one which would give the President broader authority to change Medicare based on information from advisors, or "czars", and has as a safeguard a provision for the disapproval of Congress. That bill is HR 2920, and has already passed the House. The CBO's assessment of it is, "Expanding the authority of the President to effect change in the Medicare program might lead to significant long-term savings in federal spending on health care but would also entail shifting some power from the Congress to the executive branch." "Might lead to", not will lead to, as is exemplified later in the statement with, "In CBO's judgment, the probability is high that no savings would be realized, for reasons discussed in the letter, but there is also a chance that substantial savings might be realized." How much do they estimate in savings? "CBO estimates that enacting the proposal, as drafted, would yield savings of $2 billion over the 2010-2019 period (with all of the savings realized in fiscal years 2016 through 2019) if the proposal was added to H.R. 3200." In a system that costs $480 billion annually, is it really going to help if we can only save 0.4% of that colossus by giving the President control over it? Personally, I don't believe so any more than I believe 0.4% is a "significant long-term savings".

Yet we still need healthcare reform, so where should we start? Having followed the rising cost of healthcare for years, along with everything else, I have also watched as more and more frivolous lawsuits are filed, and higher and higher awards are being made. Since I don't believe we should regulate profits and stymie growth, as they lead to higher tax payments, more revenue for government operation and more jobs, and contend that a portion of the increase in costs can be attributed to the higher cost of operation of the insurance companies and their passing along those costs, wouldn't it make sense to find a way to help reduce those cost with the guarantee the savings would be passed down to us? Even malpractice insurance has gotten so out of hand that many of our doctors are leaving their practices, thus causing a shortage of qualified physicians. And I don't blame most attorneys, they have to make a living as well. But if we established some tighter guidelines as to what the courts can accept as valid suits or allow as awards, that would certainly go a long way toward reducing insurance premium costs for us. It might take a few months for it to begin to work, but as long as they want to dictate to insurance companies what they can and cannot charge they might as well pass legislation that would force those companies to pass along the savings to the American public. This would fit into the category of tort reform, and I don't see that happening, even though it's needed, since over 90% of Congress is comprised of attorneys and they aren't about to cut off the hand that feeds them even if they aren't personally ambulance chasers.

Then we can look into another costly aspect of healthcare, fraud and abuse. There is far more than the estimated $170 billion in Medicare fraud alone if you consider how many times insurance companies, including Medicare, are beat out of money with ridiculous claims that end up being substantiated by less than scrupulous doctors or their office managers. Then there's the abuse by home healthcare agencies who bill for things not done, and hospitals that run unnecessary tests just to warrant having a specialized piece of equipment or to boost their bottom line. Don't get me wrong, I don't have much sympathy for the insurance companies, especially those with triple net profit margins in excess of 12%, but they are not non-profits, they are profit driven and should be allowed to make a reasonable return on their investment. And I also don't believe regulating them is the answer. But that's an entirely different debate though it is related. And I believe it will become part of the discussion before it's all over.

Another aspect of all this legislation is the failure to take into consideration the additional costs of healthcare provided to illegal immigrants, something else that is blatantly missing from this "reform" legislation. There are only a few mentions of "undocumented aliens" such as Section 246 which forbids giving them a credit under Subtitle C - Individual Affordability Credits. Applicable to Section 401, Tax on Individuals without Acceptable Health Care Coverage, it is stated that this "shall not apply to any individual who is a nonresident alien", so they don't even have to pay a penalty like the rest of us do if they don't acquire coverage. Beyond that there is nothing that specifically states that undocumented aliens are not eligible for coverage under this law, even under the public option which we all end up paying for. Bottom line, if they are undocumented, they shouldn't be on our healthcare plans anyway because they are here illegally. Even though Obama stated that he would not sign legislation that includes coverage for illegal immigrants, that wording is still not included in any of the proposed legislations currently before Congress.

I wondered why the unions were so eager to see healthcare reform when this bill specifically states that they will not be affected as they already have plans that will be grandfathered in. Then it dawned on me that the unions will save millions by not having to maintain the insurance portion of their retirement funds, but don't expect them to rebate any union dues as a result. So, as usual, it seems it's all about the money for them. This would also apply to the large corporations who utilize union labor and the funds they must hold in reserve for coverage of retirees.

Therefore, I believe we can make healthcare more affordable without forcing a piece of legislation that is as flawed as this one is. We can, however, do it within each and every state without federal interference or mandates, and well we should. Utah has an excellent approach, one that can be modified to work well right here in Texas as well as any other state. Healthcare should be a responsibility of the states as defined under that pesky Tenth Amendment which defines our sovereignty. We can certainly do it considerably more effectively, more efficiently, and according to our needs, not needs as established by some bureaucrat in Washington based on "studies and surveys" conducted in Detroit or LA. But what part of the reform will we end up with, since Congress and the White House seem determined to rush into this, and will any of it actually help us? Or will it only drive up other costs, and our taxes with it, and create another "unsustainable" bureaucracy?

I have, unlike most of our members of Congress, read all 1,070 pages of the current proposed legislation, which started out as an 1,138 page document, and referenced a great deal of it back to the U.S. Code where it applies. It took me nearly a month to wade through it all and achieve a consensus of what was in it, and another two weeks to research all the pertinent data used to justify or dissuade it. I know that many of our legislators don't actually take the time to do this; they break it up into portions and assign it to staff to do, then read the summaries created by those individuals. If one of these staffers wants to ensure their boss' support of a piece of legislation, they will write a glowing summary of it glossing over anything that might reflect on it negatively. Do we want to trust decisions about changes to our healthcare to Congressional staff members, or shouldn't we insist that the elected members of Congress actually read it all themselves?

My final thoughts and concerns are that we already have government run and controlled healthcare in the form of Medicare, the VA and the Indian Health Services. If those systems are an example of what we would all be under as a nation with yet another mandated Federal government planned or run system, thanks but no thanks. They are fraught with abuse and lack of proper care for many who have no other option for their healthcare, and that fraud and abuse isn't being perpetrated by just the patients, doctors, hospitals and other associated healthcare facilities, it's by the federal employees, by the very systems themselves, and by Washington bureaucrats. If we're going to fix it, and fix it right, we need to slow down and do it piece by piece, not as a complete, rushed short-term overhaul. And not necessarily by the Federal Government, but rather by the states according to the sovereignty and powers given them by the Tenth Amendment, though they might need a nudge from both Congress and We the People.

Cherokee

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