Health Care Debate: Foolishness and Reason
David J. Weinschrott, Ph.D. Health Economist.
Note to reader: I received a copy of this email and took up the challenge to check out the
assertions of the author against the contents of HR 3200, America’s Affordable Health Choices
Act of 2009. I used the same document the author provided the link to in the email. In the
following, the author’s interpretation of various provisions of the bill is in blue text, my
comments are in green.
Many have described the bill as a “monstrosity” at 1000 pages. I am wondering how many other
pieces of major legislation get it done in as many pages. That being said, I found sections in the
bill that were referenced by the author to be quite readable and I had little difficulty in assessing
what the intent of the section was about and how the element being discussed would work.
I must confess however, that I have studied these issues for some 30 years. I began my work as a
professional economist as a junior staffer at the Rand Corporation in the late 1960s and early
70s. There I worked on early steps to the Health Insurance Experiment that enrolled individuals
in a half-dozen sites around the country to see how they would behave with different
combinations of benefit packages, premiums, co-payments and deductibles.
In the late 70s and early 80s I was assistant professor of economics at Indiana University, Purdue
University in Indianapolis where I developed a senior and graduate level course in Health
Economics. Also during those years I conducted research on health economics issues, including
a project for the National Science Foundation.
In 1986 I joined the Hudson Institute as a Research Fellow. There I led or participated in a
variety of health policy projects leading to two published reports, The Curable Crisis: Rethinking
America’s Health Care Priorities, Hudson Institute, November,1992 and Health Care Reform, Regulation, and
Innovation in the Medical Device Industry, October, 1994 Hudson Institute, co-authored with T.J.
Duesterberg, and D.C. Murray. I conducted other reports focused on the evolution of managed
care, including a review of these issues for the U.S. Navy. Since then I have conducted a halfdozen other studies on health policy issues.
I list this experience mostly as a disclaimer to explain my comment on why I found HR3200
straightforward and understandable. For persons not used to this discussion, I understand that it
may be difficult to understand how various parts of the proposal work individually and in
concert.
I offer my comments on the various points made by the author of the original email to clarify
what I believe the legislation is proposing in hopes of allaying the fears surrounding the debate. I
don’t know why the author made the points he made, I am beginning to suspect that the effort is
either a spoof or a particularly malevolent attempt to sow confusion.
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Email Addressing and message:
---------- Forwarded message ---------From: Kevin McCallum <kmac127@aim.com>
Date: Wed, Aug 26, 2009 at 10:40 AM
Subject: Fwd: Dr. Frazer letter to Senator Bayh about Health Care: Universal
healthcare/Governament run healthcare???
To: jkite@kiterealty.com, CMarsh@endeavor-re.com, karencampbellmc@yahoo.com,
mccallus@bsci.com, bmcnabb@thecaregroup.com, bkroot@iquest.net, brad@buckinghamco.com, mrobinson@yarling.com, sbindley@aol.com, tfhollett@msn.com, jgull@hjspier.com,
Dlduchon@aol.com, teneen@dobbsindy.com, steingroup@comcast.net,
bmink@modulardevices.com, juliasmccallum@aol.com, MiltBlue419@aol.com,
WSigman@bsalifestructures.com, Randy@bonedryroofing.com, mstaciallen@yahoo.com,
jjansen@charter.net, stowell@insightbb.com, mdsmiller1@msn.com, gkroot@comcast.net,
jgoldenberg@otolaryn.com, srklapper@aol.com, Jgoble@clariannorth.com, carol@buckinghamco.com
Kevin C. McCallum M.D.
President
FirstLine Personal Healthcare
11725 N. Illinois St. Suite 550
Carmel, In 46032
Office Phone: (317)814-4111
Office Fax: (317)814-4515
Cell Phone: (317)590-3976
-----Original Message----From: BobCopelandSr@aol.com
To: adriennecarte51@hotmail.com; andy@marteck.com; bhay@ritemade.com;
brent.e.troyer@key.com; bryantmilon@yahoo.com; cc_izzy@hotmail.com;
chad@diversifiedcomputer.com; Char@Mark-Rite.com; christine@mark-rite.com;
CMSKSpenc@aol.com; Craig.Stiven@averydennison.com; cwilliams991@yahoo.com; dctoys@sbcglobal.net; dkharriman1950@yahoo.com; dondctoys@sbcglobal.net;
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jmaarch@comcast.net; JodeeB@vwcownersassn.com; john@mark-rite.com;
johnson.angela@hotmail.com; km996@yahoo.com; kmac127@aim.com;
LOVOLT2K1@aol.com; margieledgerwood@msn.com; michael_p_emerson@keybank.com;
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PaulaDPremier@att.net; pstacy@catalystcmi.com; randy@mark-rite.com; robert@marteck.com;
russstaggs@sbcglobal.net; sannalore@yahoo.com; Sarah@Marteck.com;
sdlewis2000@yahoo.com; seanvansheppard@hotmail.com; slacker20032003@yahoo.com;
sskanna1@yahoo.com; stan@diversifiedcomputer.com; stephanie.castletonpaper@live.com;
2
tstacy@catalystcmi.com; WFDCARMEL@aol.com
Sent: Wed, Aug 26, 2009 9:45 am
Subject: Fwd: FW: Dr. Frazer letter to Senator Bayh about Health Care
Go on - tell me this country isn't doomed!!!
From: AONeal@kermans.com
To: roneal@tds.net, BobCopelandSr@aol.com
Sent: 8/26/2009 9:20:46 A.M. Eastern Daylight Time
Subj: FW: Dr. Frazer letter to Senator Bayh about Health Care
To read or download a PDF copy of HR3200 to check all this for yourself, go here,
http://energycommerce.house.gov/Press_111/20090714/aahca.pdf
You'd better pray for perfect health the rest of your life!
Subject: An Indianapolis doctor's letter to Sen. Bayh about the Bill (Note: Dr. Stephen E.
Frazer, MD practices as an anesthesiologist in Indianapolis , IN )
Here is a letter I sent to Senator Bayh. Feel free to copy it and send it around to all other
representatives. -- Stephen Fraser
July 23, 2009
Senator Bayh,
As a practicing physician I have major concerns with the health care bill before Congress. I
actually have read the bill and am shocked by the brazenness of the government's proposed
involvement in the patient-physician relationship. The very idea that the government will dictate
and ration patient care is dangerous and certainly not helpful in designing a health care system
that works for all. Every physician I work with agrees that we need to fix our health care system,
but the proposed bills currently making their way through congress will be a disaster if passed.
I ask you respectfully and as a patriotic American to look at the following troubling lines that I
have read in the bill. You cannot possibly believe that these proposals are in the best interests of
the country and our fellow citizens.
3
Commentary on HR 3200 with Responses
Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that selfinsure!!
The section describes a research study that examines the self-insured health insurance
markets that are currently regulated by the US Department of Labor under the socalled ERISA act. This report is a one time study - probably will conduct a sample of
financial reserves. The purpose of the research is to protect self-insured employers
from adverse selection (p23, line 2-5).
Page 30 Sec 123 of HC bill: THERE WILL BE A GOVT COMMITTEE that
decides what treatments/benefits you get.
Sec 122 (the previous section describes a "basic benefits plan" which will set the
standards for policies offered in the exchange. This basic benefits plan will defined as
"actuarially equivalent" to the average employer benefit plan in the same geographical
region. The general idea is to make sure that consumers can compare the range
of benefits in plans that are available in the exchange menu as they decide which plan
to choose. Actuarially equivalent means the plans offer similar benefits for a similar
price. Currently individuals in the private market are offered benefit structures and
prices based on their health condition. Only later when they file a claim do they
sometimes find the fine print excludes their condition.
The advisory committee in Sec 123 will identify the initial set of benefits and track
these benefit standards over time to make sure they are keeping up with technological
advance in treatment options.
Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS
RATIONED!!!
Lines 4-16 describes an element of the basic benefits / cost-sharing combination. These lines put
a limit on the amount of cost sharing not the range of benefits. (this dude either can't read or is
deliberately falsifying his analysis.)
Page 42 of HC Bill: The Health Choices Commissioner will choose
your HC benefits for you. You have no choice!
This section describes how the Commissioner will determine whether insurance firms actually
provide the benefits they claim they are providing - in a manner similar to what state health
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insurance commissioners do now at the state level. His work is to be done in coordination
with those state regulators as well as the US DOL that currently regulates self-insured plans
noted above. This is mainly a consumer protection issue. Consumers and/or employers choose
their benefits plans that are offered either inside or outside the exchange. The purpose of the
exchange, among other roles, is to make sure that no person can be denied an affordable health
insurance plan.
Page 50 Section 152 in HC bill: HC will be provided to ALL non-US
citizens, illegal or otherwise.
Section 152 prohibits discrimination in the supply of health benefits based on
characteristics un-related to the health care itself. On the other hand section 246 does
exclude subsidies for undocumented aliens. If such aliens can purchase insurance
without subsidy, they are not prevented from doing so - just as they are not prevented
from buying auto insurance or autos, for that matter!
SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
ALIENS.
Nothing in this subtitle shall allow Federal payments
for affordability credits on behalf of individuals who are
not lawfully present in the United States.
Page 58 HC Bill: Govt will have real-time access to individuals'
finances & a 'National ID Health card' will be issued!
This section is designed to simplify communication between physicians and insurance
plans. The term "financial responsibility" for the consumer applies their deductible or
copayment provisions in their plan. This information will be encoded on their
insurance card so physicians will know whether to charge a co-payment or not. These
provisions will be standardized so physicians are using the same system for all
patients / insurance plans. This has nothing to do with an individual's personal
finances!
Page 59 HC Bill lines 21-24: Govt will have direct access to your
bank accounts for elective funds transfer.
This portion continues the previous material in defining how doctors will be paid from
insurance firms. Again all insurance firms would use the same approach for
reimbursing physicians so physicians don't have to manage different systems.
5
Page 65 Sec 164: Is a payoff subsidized plan for retirees and their
families in unions & community organizations: (ACORN).
Because of the high and rising cost of health insurance many employers that
have previously covered their retirees under the age of 65 (therefore not eligible
for Medicare) have been canceling these plans. Those retirees are then forced into the
individual market where they are often denied coverage. This section provides a way
for the federal government to lower the cost for employers to provide these benefits
to their former employees. The section seems to be temporary (line 17) - perhaps to
allow retirees to transition to other coverage offered in the exchange. The
participation defines persons who are in retiree plans with their former employers not members of community organizations.
Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for
private HC plans in the 'Exchange.'
This section defines how insurance plans are offered in the exchange. Remember that
some exchange areas may be rural areas with sparse populations. The requirements
are that no insurance firm can only offer an expensive plan without also offering the
basic plan. The section talks about basic, enhanced, premium and premium-plus plans
- much like bronze, silver and gold plans in the old Blue Cross approach.
So consumers will not be forced into a corner of only having a gold plan available
when they can only afford (or want!) a bronze plan. Also the insurance firms cannot
attach co-payment to certain preventive services like mammograms.
Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans -The Govt will ration your health care!
These provisions implement the recommendations of the advisory committee
mentioned above. It defines the benefits of plans offered through the exchange - much
the way state health commissioners do now. The basic benefits package is defined as
actuarially equivalent to the average employer provided benefit package in the
region. These plans will generally have lower premiums with co-payments for nonpreventative services. Higher cost plans will role costs into the premium in exchange
for not charging co-payments. If you are young you can opt for the basic plan and
only face additional out of pocket costs when you use services. Older subscribers
may prefer to make a higher monthly premium payment and not face co-payments.
The section make sure these trade-offs between premiums and co-payment
combinations are fair.
6
Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate
services. (Translation: illegal aliens.)
Communication with individuals who are English challenged is a good thing - most
physicians do so already if they have many such persons in their practice. However we established above that illegal aliens are specifically prohibited from receiving
public subsidies in section 246. Of course such individuals are not prohibited from
purchasing either insurance or medical care - only from receiving a public subsidy.
Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN &
Americorps to sign up individuals for Govt HC plan.
Another example of a mean-spirited opinion. Because the insurance companies are
only going to forgo underwriting (i.e., denying coverage based on health conditions) if
EVERYONE is enrolled, one must specify a method to assist individuals to sign up especially those who may have difficulty navigating a health insurance exchange. (By
the way, this navigation will be easier than navigating the current private health
insurance market.) This is not different from organizations like SHIP which assists
older Americans in enrollment in Medicare or in Part D or Part C prescription drug or
Medicare Advantage plans. Nor is it different than many states in assisting in
enrollment in SCHIP - the state children's health insurance program. What is wrong
with AmeriCorps (or Acorn for that matter) to assist in this process? The whole
Acorn flap was a red herring anyway if one takes the trouble to check it out - but this
dude has difficulty reading anyway.
Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans.
(AARP members - your health care WILL be rationed!)
Same as two items above - same section
Page 102 Lines 12-18 HC Bill: Medicaid eligible individuals will be
automatically enrolled in Medicaid. (No choice.)
Read the Text. (lines 12-18)! Persons who do not join a plan in the exchange will be
enrolled in Medicaid. Looks like a choice to me?
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Page 12 4 lines 24-25 HC: No company can sue GOVT on price
fixing. No "judicial review" against Govt monopoly.
What monopoly? This section indicates how rates will be set for providers who
provide services for individuals enrolled in the public health plan sold through the
exchange. It does not apply to providers providing services to individuals enrolled in
private plans in the exchange or in private plans not sold through exchange. In any
case providers can opt out of providing such services if they wish. Secondly the rates
set here are based on rates that apply to current Medicare coverage. There is no
monopoly since the bulk of customers will be enrolled in private plans.
Moreover, the business about judicial review applies only to innovative
pricing mechanisms that are intended to be experimental departures from typical feefor-service which are known to contribute to medical price inflation. An example of
such an approach would be to bundle all services for a hospital stay under a single
payment amount rather than let hospitals bill separately for separate procedures,
prescriptions, etc. These piece-wise billing procedures give the incentive for providers
to provide unnecessary (not health beneficial) procedures. We have to learn how to
mange this stuff better if we are going to reign in the current unsustainable cost
trajectory. Many insurance firms are also experimenting with these pricing reforms.
Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association
- The Govt will tell YOU what salary you can make.
Most physicians do not get paid a salary; their income derives from fees they charge
for specific services. Private insurers, Medicare and Medicaid negotiate rates with
many doctors. The total income physicians make depends on their specialty, how hard
they work and the mix of patient types that are in their practice. This section, like
Medicare, sets rates under the public insurance option and defines classes of
physicians as "preferred" those that accept those rates as their full charge as "nonpreferred" those who do not accept those rates but agree to not charge higher than a
specific ratio relative to the specified rate. This section is about defining those
groups, not rates.
8
Page 145 Line 15-17: An Employer MUST auto-enroll employees
into public option plan. (NO choice!)
This section begins to describe how employers have a responsibility either to enroll
each employer in their own employer based plan or contribute a specified amount per
employee if the employer does not provide employer based coverage. Sometimes an
employee would choose to belong to the same plan as their spouse who works for
another employer - so in this case the employer makes a contribution in that direction.
The employee can choose the employer plan or an exchange plan, but must be
enrolled somewhere. The auto-enrollment only occurs if the employee doesn't elect
coverage - everyone must be coverage so the deal with the insurance companies is
fulfilled. The notion that the employer auto-enrolls employees into a public plan is
simply not true - in fact the usual case is that an employee who doesn't elect a choice
will be enrolled in the employer's private plan. Line 20 on page 147 is titled:
Automatic enrollment for Employer Sponsored Health Benefits.
Page 126 Lines 22-25: Employers MUST pay for HC for part-time
employees AND their families. (Employees shouldn't get excited
about this as employers will be forced to reduce its work force,
benefits, and wages/salaries to cover such a huge expense.)
I think he is referring to page 146.
Two major errors here in reading the bill. (1) the amount the employer must provide is
pro-rated according to the ratio of actual hours to full-time hours. (2) Any reduction
in pay to compensate for payment for health coverage will not be counted as the
required employer contribution. These provisions prevent the employer from
"gaming" the system - i.e., converting all employees to part time or summarily
reducing wages. This whole process only works if everyone plays according to the
rules - when that happens all parties will benefit. Even insurance companies - since
they will have a vast new customer base!
Page 149 Lines 16-24: ANY Employer with payroll 401k & above
who does not provide public option will pay 8% tax on all payroll!
(See the last comment in parenthesis.)
Any employer who does not provide health coverage (private outside the exchange or
private inside the exchange) will pay 8% if their payroll is above $401K. Smaller
9
employers pay a smaller percentage or none at all. Again the mistake is made that all
employees must be enrolled in the public option.
Page 150 Lines 9-13: A business with payroll between $251K &
$401K who doesn't provide public option will pay 2-6% tax on all
payroll.
Same point as above
Page 167 Lines 18-23: ANY individual who doesn't have acceptable
HC according to Govt will be taxed 2.5% of income.
A tax is imposed on persons who do not have health coverage. The 2.5% is applied to
any income over a certain amount, the lower a person's income, the lower the tax paid.
Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt
from individual taxes. (Americans will pay.)
WRONG: The tax is not paid, since these folks cannot get publicly
subsidized insurance! - Sect 246.
Page 195 HC Bill: Officers & employees of the GOVT HC Admin.
will have access to ALL Americans' finances and personal records.
Income information will be available only for persons who cannot afford coverage
and who will be receiving the public subsidy, i.e., those persons whose income is
relevant in determining the "affordability credit." This is not different that what is
required for getting Medicaid, SSI, and subsidized prescription drugs under Medicare
Part D.
Page 203 Line 14-15 HC: "The tax imposed under this section shall
not be treated as tax." (Yes, it really says that!)
This comment looks kind of crazy, but it has nothing to do with policy. It is in a
section that specifies a research project to determine how much savings occur in
government spending on health care due to the payment reforms etc. The specific
statement has to do how certain measures of health expenditures will be defined. In
order to figure out why (or if) this statement makes sense, one would have to dig into
the research design, but it has nothing to do with the implementation of the program.
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Anyone who would jump to a conclusion about this statement (especially based on the
track record so far) should just be quiet.
Page 239 Line 14-24 HC Bill: Govt will reduce physician services for
Medicaid Seniors. (Low-income and the poor are affected.)
This section does not mention Medicaid, nor seniors etc. The section describes how
certain data will be used in determining the "target growth rate" computation
in defining inflation adjustment rates. There are no services to anybody in sight in this
text. Moreover, the so-called Medicaid Seniors are persons who are on Medicare and
whose income is so low they can't afford to pay their premiums for part B (or part D)
coverage. In that case Medicaid helps pay those premiums. There is no means by
which services can be reduced just because Medicaid is helping to pay the premium.
Page 241 Line 6-8 HC Bill: Doctors: It doesn't matter what specialty
you have trained yourself in -- you will all be paid the same! (Just
TRY to tell me that's not Socialism!)
This is part of the previous discussion where the growth rate is being computed in
order to adjust payments for inflation. The equality here applies to the inflation rate
adjustment, not the underlying rate. In other words the adjustment for inflation with
be the same across specialties, even though the underlying rates are not. It would be
pretty difficult to come up with specialty-specific inflation rates!
Page 253 Line 10-18: The Govt sets the value of a doctor's time,
profession, judgment, etc. (Literally-- the value of humans.)
This section describes the process of applying relative value rates which determine the
relative value of services provided across specialties. Here is some background on
these scales and how they are determined.
Most insurers, however, tee their payment rates for physicians off Medicare
reimbursement rates. Medicare’s physician fee rates are based on the relative cost of
providing services determined something called the Resource-Based Relative Value
Scale (RBRVS). A panel of medical doctors, through the American Medical
Association, updates the relative work values every five years based on: the time it
takes to perform the service, the technical skill and physical effort, the required
mental effort and judgment, stress due to the potential risk to the patient, malpractice
rates in the area, and other geographic adjustments to reflect cost variation before
coming up with a number. The process is also open to public comment and private
health insurers — along with anyone else — have an opportunity to weigh in on the
process and the rates
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Note that these scales are updated by a panel of doctors through the
American Medical Association, and that most private insurers use the same
system.
Page 265 Sec 1131: The Govt mandates and controls productivity
for "private" HC industries.
WRONG: the text refers to how measured productivty gains are incorporated into
the construction of price indexes. Since the array of services being provided in and
out of the hospital is constantly changing (services are moving out of the hospital) the
cost analysis and rate setting formulas have to be adjusted. This has been going on for
years with Medicare purchase of medical services. This section is about how to use
measurements of productivity, not imposing productivity - as if that were possible!
Page 268 Sec 1141: The federal Govt regulates the rental and
purchase of power driven wheelchairs.
This section just broadens the definition of mobility assistance devices that Medicare
will pay for
Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER
HOSPITALS - Cancer patients - welcome to rationing!
This section has two parts. (1) conduct a study to determine if ambulatory cancer
treatment centers cost more for certain services as compared to other (community)
hospitals. (2) if so then there is to be an positive adjustment in the payment to
the ambulatory treatment centers.
Page 280 Sec 1151: The Govt will penalize hospitals for whatever the
Govt deems preventable (i.e...re-admissions).
Increasingly hospitals are being ranked with respect to who well they deliver medical
care. For example hospitals that have higher rates of staph infections or rates of
iatrogenic disease are judged to be producing sub-standard care. In this case there are
hospitals that have higher rates of readmission than would be expected and thus would
be thought to provide sub-standard care. Physicians try to avoid those hospitals. This
section discusses how payment to those hospitals will be adjusted downward - on the
assumption that hospitals that provide better care should be rewarded. Note that the
adjustment is based on "risk-adjusted" re-admission rates. This means that the
comparison takes into account the relative severity of the cases treated in different
12
hospitals. Those hospitals who treat a more severely diseased population would be
expected to have a higher re-admission rates and would not be penalized.
Page 298 Lines 9-11: Doctors: If you treat a patient during initial
admission that results in a re-admission -- the Govt will penalize
you.
This section describes a proposed study to determine how to assign some of the cause
for excess re-admission rates to physicians. Perhaps the re-admission was due to a
faulty diagnosis or treatment plan. Just like everyone else, payment is going to
reward better outcomes. Again the study would be conducted with risk-adjusted
measures as noted in the previous item.
Page 317 L 13-20: PROHIBITION on ownership/investment.
(The Govt tells doctors what and how much they can own!)
It is generally considered unethical for physicians to refer patients to hospital or clinic
facilities in which they own a substantial interest. There is enough research to show
that such arrangements are associated with higher than normal levels of procedures.
However this section recognizes that the usual blunt force provision may be overly
sensitive in the case of rural hospitals where local physicians may also be investors.
So this section loosens up the restrictions and proposes other tests to determine if
there is the possibility of harmful incentives involved in the referral.
Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion. (The
Govt is mandating that hospitals cannot expand.)
Same issue as above, the issue here is that the hospital should not be guaranteeing the
loan that permits the physician to make the investment that he then refers his patients
to. Sounds like a good idea to me!
Page 321 2-13: Hospitals have the opportunity to apply for exception
BUT community input is required. (Can you say ACORN?)
FACT: there are actually community organizations that are not part of or related to
ACORN. This section still has to do with physician investment in hospitals to which
they refer patients. Remember - these are likely to be for-profit hospitals that pay
13
dividends - those dividends would go to physicians who are shareholders in the
hospital. The question here is, again, would the ownership role influence the
physician's referral patterns. Would the physician refer to a local low service hospital
in which he/she has ownership when a regional hospital is better equipped for the
patient's needs. Certainly most physicians would not be affected - this provision
reduces the risk. However the community (the other investors) is allowed to make a
judgment. It is getting tiresome to hear the refrain that any sentence containing the
word "community" necessarily means ACORN is involved.
Page 335 L 16-25 Pg 336-339: The Govt mandates establishment
of=2 outcome-based measures. (HC the way they want -- rationing.)
These outcome measures (HEDIS and CAHPS) have long been used among private
insurers (and self-insured employers) to measure the effectiveness of their provider
networks. They are being applied here to Medicare (Part C) Advantage plans. Again
the focus is on productivity measured in terms of the quality of care delivered. If we
don't work on these issues we will never be able to bend the cost curve downward.
The current increase in costs is unsustainable.
Page 341 Lines 3-9: The Govt has authority to disqualify Medicare
Advance Plans, HMOs, etc. (Forcing people into the Govt plan.)
The rules under which Medicare Advantage (not advance plans) are determined
by Medicare. In these plans the government allows a private insurance plan to receive
part A and part B premiums usually paid to Medicare and thus provide both medical
and insurance services. Of course such plans that perform poorly could be
disqualified. They do not have a constitutional right to use resources otherwise
allocated to Medicare, especially when Medicare pays them 15-20% more than other
medical providers. This has nothing to do with HMOs in general only those that are
part of a Part C arrangement.
Page 354 Sec 1177: The Govt will RESTRICT enrollment of 'special
needs people!' Unbelievable!
On this one, I am going to make a guess, since we don't have enough information to
make a definitive judgment. One would have to check the provisions of the
Social Security act amendments that are cited here. Apparently there was an
experiment of sorts conducted with state governments in a joint MedicareMedicaid medical service plan. These plans served persons with disabilities i.e., they
14
were receiving SSI services along with Medicare and they were of low income. The
plan perhaps was dealing with the issue of whether these plans should include mostly
persons with severe disabilities or perhaps a mix of patients - hence the issue of
restricted enrollment. These arrangements had been previously approved by CMS.
Basically this provision extends the time period before the final report is due from
2011 to 2016.
Page 379 Sec 1191: The Govt creates more bureaucracy via a "TeleHealth Advisory Committee." (Can you say HC by phone?)
Note that this issue is in connection with rural hospitals. There has been increasing
use of electronic communications between smaller staffed rural hospitals and larger
urban hospitals with more specialty depth. These systems provide real time sharing of
images and measurements of vital signs and other measurements to specialists who
can then consult with the local doctor. This increases the quality of medical care in
rural areas. This section just sets up an advisory committee to aid the Secretary in
making decisions about these issues.
Page 425 Lines 4-12: The Govt mandates "Advance-Care Planning
Consult." (Think senior citizens end-of-life patients.)
This has been dealt with ad nauseam. It merely grants authority to pay physicians to
consult with patients about use of hospice care or living will declarations. These
issues all involve technical health care considerations - why wouldn't patients want to
consult their physicians. why shouldn't physicians be paid for this activity - or should
they only get paid for getting out their scalpel?
Here is the same point by AMA president:
"There has been a lot of misinformation about the advance-care planning provisions in
the bill," AMA President J. James Rohack, MD, said in a statement. "Simply put, the
bill would create a new Medicare benefit to pay physicians for time spent on advancecare planning consultations with seniors. It would be completely voluntary, and it will
allow patients, if they wish, to discuss a broad range of issues, including hospice,
living wills, advance directives and appropriate pain care.
Page 425 Lines 17-19: The Govt will instruct and consult regarding
living wills, durable powers of attorney, etc. (And it's mandatory!)
Same issue as above - and its voluntary and it’s a benefit!
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Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an
"approved" list of end-of-life resources; & nbsp;guiding you in
death. (Also called 'assisted suicide.')
Same issue as above - and its voluntary and its a benefit!
although such a list would be helpful
Doesn’t say approved -
Page 427 Lines 15-24: The Govt mandates a program for orders on
"end-of-life." (The Govt has a say in how your life ends!)
All this these provisions indicate what kinds of consultation the government will pay
for, not the content of the consultation nor, for God's sake, the type of decision the
patient, family and clergy would actually make.
Page 429 Lines 1-9: An "advanced-care planning consultant" will be
used frequently as a patient's health deteriorates.
Same as above
Page 429 Lines 10-12: An "advanced care consultation" may include
an ORDER for end-of-life plans. (AN ORDER TO DIE FROM
THE GOVERNMENT?!?)
The term used in the text is "order for life sustaining treatment" Families all over the
country have to make these difficult decisions about whether to revoke an order for
life sustaining treatment - like a respirator or heart and lung machine. The plan isn't
the "order" the plan is the decision process by which a family makes a decision about
these matters. This provision pays for the physician's time to help them. There has
been some confusion about how these plans should be worded in different states and
thus provide clear guidance to physicians FROM THE FAMILY. This helps resolve
the potential for confusion.
Page 429 Lines 13-25: The GOVT will specify which doctors can
write an end-of-life order. (I wouldn't want to stand before God
after getting paid for THAT job!)
Same issue! Enough already.
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Page 430 Lines 11-15: The Govt will decide what level of treatment
you will have at end-of-life! (Again -- no choice!)
Same issue! Enough already.
Page 469: Community-Based Home Medical Services = Non-Profit
Organizations. (Hello? ACORN Medical Services here!?!)
Is this guy a real physician. Has he never heard of Visiting Nurses and 50 other
agencies that provide home based medical care? Don't think there are many named
ACORN.
Page 489 Sec 1308: The Govt will cover marriage and family
therapy. (Which means Govt will insert itself into your marriage
even.)
Apparently adds marriage and family therapy - a provision that promotes parity in the
coverage of medical and mental health services. Widely supported because of the
widespread incidence of co-morbidity between mental and medical conditions. Many
medical conditions cannot improve until the mental issues are also dealt with. There is
a lot of research on this issue in both medical and mental health journals.
Page 494-498: Govt will cover Mental Health Services including
defining, creating, and rationing those services.
Same as above...
Senator, I guarantee that I personally will do everything possible to
inform patients and my fellow physicians about the dangers of the
proposed bills you and your colleagues are debating.
Furthermore, if you vote for a bill that enforces socialized medicine
on the country and destroys the doctor-patient relationship, I will do
everything in my power to make sure you lose your job in the next
election.
Respectfully,
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Stephen E. Fraser, MD
Dear Reader,
I urge you to use the power that you were born with (and the power that may soon be taken
away)
and circulate this email to as many people as you can reach. The Power of the People can stop this
from happening to us, our parents, our grandparents, our children, and to following generations.
In doing
your part you are a great American!
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