Shock: Inside the Healthcare Bill, Part 2

Hey guys!

I’m 100% AGAINST this bill.....but!
Let’s maintain our credibility.
I see references to coverage for illegal immigrants in the summaries here.
Yet, in the bill itself I find:
SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
4 ALIENS.
5 Nothing in this subtitle shall allow Federal payments
6 for affordability credits on behalf of individuals who are
7 not lawfully present in the United States.

So, unless somebody can explain the difference, I’m inclined to be skeptical of these summaries.

"results of the study (audit) will be used to “Make Recommendations” to ensure that incentives for(all) self-insuring does not exist.

That help?

Straight from the bill:

•HR 3200 IH Page 21
1 SEC. 113. INSURANCE RATING RULES.
2 (a) IN GENERAL.—The premium rate charged for an
3 insured qualified health benefits plan may not vary except
4 as follows:
5 (1) LIMITED AGE VARIATION PERMITTED.—By
6 age (within such age categories as the Commissioner
7 shall specify) so long as the ratio of the highest such
8 premium to the lowest such premium does not ex9
ceed the ratio of 2 to 1.
10 (2) BY AREA.—By premium rating area (as
11 permitted by State insurance regulators or, in the
12 case of Exchange-participating health benefits plans,
13 as specified by the Commissioner in consultation
14 with such regulators).
15 (3) BY FAMILY ENROLLMENT.—By family en16
rollment (such as variations within categories and
17 compositions of families) so long as the ratio of the
18 premium for family enrollment (or enrollments) to
19 the premium for individual enrollment is uniform, as
20 specified under State law and consistent with rules
21 of the Commissioner.
22 (b) STUDY AND REPORTS.—
23 (1) STUDY.—The Commissioner, in coordina24
tion with the Secretary of Health and Human Serv25
ices and the Secretary of Labor, shall conduct a
26 study of the large group insured and self-insured
VerDate Nov 24 2008 23:22 Jul 14, 2009 Jkt 079200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H3200.IH H3200 jlentini on DSKJ8SOYB1PROD with BILLS
22
•HR 3200 IH PAGE 22
1 employer health care markets. Such study shall ex2
amine the following:
3 (A) The types of employers by key charac4
teristics, including size, that purchase insured
5 products versus those that self-insure.
6 (B) The similarities and differences be7
tween typical insured and self-insured health
8 plans.
9 (C) The financial solvency and capital re10
serve levels of employers that self-insure by em11
ployer size.
12 (D) The risk of self-insured employers not
13 being able to pay obligations or otherwise be14
coming financially insolvent.
15 (E) The extent to which rating rules are
16 likely to cause adverse selection in the large
17 group market or to encourage small and mid
18 size employers to self-insure
19 (2) REPORTS.—Not later than 18 months after
20 the date of the enactment of this Act, the Commis21
sioner shall submit to Congress and the applicable
22 agencies a report on the study conducted under
23 paragraph (1). Such report shall include any rec24
ommendations the Commissioner deems appropriate
25 to ensure that the law does not provide incentives
PAGE 23
1 for small and mid-size employers to self-insure or
2 create adverse selection in the risk pools of large
3 group insurers and self-insured employers. Not later
4 than 18 months after the first day of Y1, the Com5
missioner shall submit to Congress and the applica6
ble agencies an updated report on such study, in7
cluding updates on such recommendations.

Please point out where it says “Mandatory Audit of all self insuring businesses”

Thanks

Is there any way we could boil these summaries down to the most critical points, eliminate some of the repetition, and quote straight from the bill?

Download the bill and look up the relevant pages.

ObamaCare and me
By Zane F Pollard, MD
I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a doctor.

First off, the government has involved very few of us physicians in the healthcare debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.

I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.

Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point — rationing of care.

Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.

Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous.

Last week I had a lady bring her child to me. They are Americans but live in Sweden, as the father has a job with a big corporation. The child had the onset of double vision 3 months ago and has been unable to function normally because of this. They are people of means but are waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be put on a 6 month waiting list. She called me and I saw her that day. It turned out that the child had accommodative esotropia (crossing of the eyes treated with glasses that correct for farsightedness) and responded to glasses within 4 days, so no surgery was needed. Again, rationing of care.

Last month I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year old judge with vertical double vision. His surgery went very well and now he is happy as a lark. I have been told — but of course there is no healthcare bill that has been passed yet — that these 2 people because of their age would have been denied surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.

I spent two year in the US Navy during the Viet Nam war and was well treated by the military. There was tremendous rationing of care and we were told specifically what things the military personnel and their dependents could have and which things they could not have. While I was in Viet Nam, my wife Nancy got sick and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family’s private internist in Beverly Hills. While it was expensive, she received an immediate work up. Again rationing of care.

For those of you who are over 65, this bill in its present form might be lethal for you. People in England over 59 cannot receive stents for their coronary arteries. The government wants to mimic the British plan. For those of you younger, it will still mean restriction of the care that you and your children receive.

While 99% of physicians went into medicine because of the love of medicine and the challenge of helping our fellow man, economics are still important. My rent goes up 2% each year and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for a cataract surgery and today $500. This is a 73% decrease in our fees. I do not know of many jobs in America that have seen this sort of lowering of fees.

But there is more to the story than just the lower fees. When I came to Atlanta, there was a well known ophthalmologist that charged $2500 for a cataract surgery as he felt the was the best. He had a terrific reputation and in fact I had my mother’s bilateral cataracts operated on by him with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.

However, then the government came in and said that any doctor that does Medicare work cannot accept more than the going rate ( now $500) or he or she would be severely fined. This put an end to his charging $2500. The government said it was illegal to accept more than the government-allowed rate. What I am driving at is that those of you well off will not be able to go to the head of the line under this new healthcare plan, just because you have money, as no physician will be willing to go against the law to treat you.

I am a pediatric ophthalmologist and trained for 10 years post-college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years).A neurosurgeon spends 14 years post -college, and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes, but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already, the top neurosurgeon at my hospital who is in good health and only 52 years old has just quit because he can’t stand working with the government anymore. Forty-nine percent of children under the age of 16 in the state of Georgia are on Medicaid, so he felt he just could not stand working with the bureaucracy anymore.

We are being lied to about the uninsured. They are getting care. I operate at least 2 illegal immigrants each month who pay me nothing, and the children’s hospital at which I operate charges them nothing also.This is true not only on Atlanta, but of every community in America.

The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.

Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not trust any doctor that would work under these draconian conditions.

One last thing: with this new healthcare plan there will be a tremendous shortage of physicians. It has been estimated that approximately 5% of the current physician work force will quit under this new system. Also it is estimated that another 5% shortage will occur because of the decreased number of men and women wanting to go into medicine. At the present time the US government has mandated gender equity in admissions to medical schools .That means that for the past 15 years that somewhere between 49 and 51% of each entering class are females. This is true of private schools also, because all private schools receive federal funding.

The average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days. I have now trained 35 fellows in pediatric ophthalmology. Hands down the best was a female that I trained 4 years ago — she was head and heels above all others I have trained. She now practices only 3 days a week.

What I’d like the most is an analysis where the bill text is interleaved with commentary.

ABC national news tonight took a “close look” at the end-of-life counseling part of the bill. They indicated that the counseling is harmless, voluntary, etc.

As I see it, the counseling is not what we need to worry about. The rules themselves, which counselors must adhere to, is where the problems will lie. Perhaps the legislation now says that specific rules will be concocted as time goes on.

I’m skeptical that interpretations mentioned or reference on this board are biased toward opposing the legislation. That’s why bill text interleaved with commentary will help me.

In case you’re wondering, though my knowledge of the bill is limited, I hate it and also that conceited, dishonest, socialist Obama.

Nevertheless I seek the truth.

I am strongly against government control of most things. This Health Care/Insurance Reform is just a power grab. I have read plenty in the House legislation that makes me want to hurl. Having said that, I think everyone should open the bill in one window, and the article in another. Then move to the referenced pages in the article. One by one. I would not accept the writer’s interpretations for yourself. I just began doing this with the first article, “Shock: Inside the Health Care Bill”. I have found a number of items listed that are wrongly interpreted or just plain wrong.

If I get the opportunity to attend a town hall meeting in my district (not likely in Western New York), I will have a list of references that I have confirmed by reading the text myself. I don’t want to be embarrassed by citing BS.

Here’s one example from the first article:

“Pg 29 lines 4-16 in the HC bill - YOUR HEALTHCARE IS RATIONED!!!”

Here is the text from the bill:

“(2) ANNUAL LIMITATION.—
(A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).
(B) APPLICABLE LEVEL.—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
(C) USE OF COPAYMENTS.—In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.”

It sounds to me like maximum co-pay amounts are being defined. This is almost as bad as health care rationing in my view, because it represents another tax. We’ll be taxed at the payroll level and again when we collect services. Unless we meet the low-end income criteria. Still, it doesn’t seem to be what is referenced in the article.

Fwiw.

If you go to the link he has the full bill and you can take whatever parts you need right from the source.

Also when I posted the first article someone here did an excellent job cleaning it up do a search with the title shock inside the healthcare bill you should be able to find it.

Here was the original post hope it helps

http://www.freerepublic.com/focus/f-news/2297439/posts

>>> do you need someone to read it for you and act it out as well?

My reading of page 22 (using context from 21 and 23) is that this page(s) of the bill authorizes nothing more than a study for the purposes of recommending changes... (For Closing loopholes and discouraging self insurers)

Page 21, Line 25:shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:

Page 22, line 19: (2) REPORTS.—Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable gencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers. Not later than 18 months after the first day of Y1, the Commissioner shall submit to Congress and the applicable agencies an updated report on such study, including updates on such recommendations.

Looking futher, seems I'm missing something too. Seems this list is completely bogus, or is out of sync with the origional HC bill.

I think there is a better summary about.

>>> I think there is a better summary about.

lets hope so... all it takes is one disprovable summary, and the entire thing is trash.

I didn’t even get past #1.

This was recently posted but deserves repeating: