HEALTHCARE OBAMANATION

I started to write this several months ago, but I have been having difficulties with motivation for about five months. When I do sit down to write, I have difficulty. The reason I'm saying this is because a number of changes have been bounced back and forth since I analyzed the bill myself, but I'm confident the changes made little material difference.

My experience with counter-political groups in the past, particularly with their legislative committees, leaves me little concerned that any significant change has taken place. In cases of “controversial” legislation like this, laws the people don't want but the money powers do, a great show is usually made about changes being made to the bill and different versions being sent back and forth between committees and between the Senate and the House. These changes are usually cosmetic, but they give Senators and Representatives (Gauleiters?) an opportunity to go back to constituents with claims that they fought hard to stop the bill in its original form. In the end, they “compromised” and voted for this “improved” plan as the only means to stop the original. This show also makes it extremely difficult for those of us who have lives to lead to keep up with those minor changes. It gives those pushing the bill a chance to attack opposition on insignificant “errors” in their analysis created by those minor changes. Knowing fully that I will be vulnerable, I'm still publishing this based on my original analysis of an earlier house Bill with some updates from other sources.

A lot has been written by both sides of the argument about “Obama's” healthcare plan. Each side tries to analyze it from its own perspective and explain what is in it and what it will do. All is futility.

The plan, as represented by the Bill passed by the House of Representatives*, can't be analyzed in terms of content or effect. It is a grotesque skeleton that will be fleshed out later by the new monstreaucracy it creates and by the courts that will hear what is likely to be a storm of lawsuits to try to limit or to expand its meaning and scope.

Much of the job of fleshing out; that is, actually creating the “health care” system falls on two people and the massive bureaucracy that will by necessary to do the actual work. When I first examined this atrocity, I thought it set up what was, in effect, a Health Care Dictator. A “Health Choices Commissioner” is created and is mentioned over 200 times, usually establishing his/her considerable powers, discretions, and dutes. However, as I delved further into the bill, I found that the Commissioner, while having incredible power in his own right, may be subservient to a higher level dictator – the “Secretary of Health and Human Services.”

Again, the “Health Care Commissioner and his duties are mentioned over 200 times in the bill. Among those duties are:

defining what a “dependent” is, - the bill doesn't even define something as basic as a dependent
establishing rules for Exchange-participating health benefits plans
establishing a “grace period” whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan [so much for not effecting your current plan]
specifying age categories wherein limited age variation [premium] is permitted
specifying, in consultation with State insurance regulators, variations permitted by premium rating area [note that it requires such consultation but doesn't require the Commissioner to listen to the State regulators – it will probably be left to the courts to settle any jurisdictional arguments]
specifying conditions for family enrollment variations (such as variations within catagories and compositions of families) as specified under State law and consistent with rules of the Commissioner [no specification in the bill as to which takes priority creating an area for ongoing legal battles]
defining a “medical loss ratio” that must be met by a qualified health benefits plan

This is just a very small sampling. The defining, establishing, and specifying, not to mention requiring reports and, in turn, writing reports, goes on for most of the 200 plus times the Commissioner is mentioned.

As regards reports required of the “qualified health benefits plans,” I found this section fascinating.

The Health-care Commissioner is charged with establishing standards with which a “qualified health benefits plan” must comply “for the accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information as determined appropriate by the Commissioner. The Commissioner shall require that such disclosure be provided in plain language.” According to the bill, “plain language” means “language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clean, concise, well-organized, and follows other best practices of plain language writing.”

I find this section fascinating for several reasons:

Firstly, the number and nature of things the plan providers, and presumably, the health care providers must keep statistics on and report to the Commissioner. How can anyone even guess what the cost of this record keeping and reporting is going to be? Estimates of the cost of this bill have ranged from $800 million to $2 or 3.5 trillion. Is that just for the medical coverage or does it includes this massive record keeping and reporting? Is it only for the record keeping and reporting? I doubt that even the people who made the estimates could tell us.
Secondly, and this I find both fascinating and enlightening, is that “plain language” is defined as language that an intended audience which would include those whose English no so pretty much good. Would that include illegal aliens? Is ability to speak English not a requirement for naturalization? It must not be for the users of the system. What use would most patients have for such statistics? Is it intended for the health care providers? Maybe they've already anticipated driving all American doctors from the field and having to replace them with foreign doctors. On the other hand, maybe this is just a smokescreen to hide the inability of the bureaucrats and elected officials who are promising to “reform” health care and the insurance industry to speak the language of either.
Finally, and this should be good, the Commissioner is charged with developing and issuing guidance on best practices of plain language writing. Isn't that a kicker? These people, famous for unintelligible bureauese, will be providing “guidance” for plain English writing. Of course they might be planing to subcontract the writing to technical writers in China or India. You know—the ones who wrote the manuals for your computer, home appliances, and the items you bought that said “some assembly required.” Maybe they're planning to make Henry Kissinger Secretary of Plain English.

The “Secretary” is mentioned close to 1100 times. Again, when mentioned, the bill does not give detailed instructions to the “Secretary,” rather, as in the case of the “Commissioner,” it specifies the powers and duties of the “Secretary” which again entail considerable discretionary latitude.

A couple of examples:

the Secretary is given the power to define and develop methodology for “Interim Rules for determining how to calculate the medical loss ratio which will subsequently be built on by the Commissioner
receives recommendations from the Health Benefits Advisory Committee on benefit standards [Behold! A bureaucracy within a bureaucracy!]

There are then several paragraphs regarding the Secretary accepting or rejecting the recommendations which he apparently must do as a package. If he/she doesn't accept, the package is sent back to the committee for revision. Most of those paragraphs is written in “plain English” I suppose, so I have no idea what they are saying. But finally, we get to this:

the Secretary shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards. [anyone want to guess what the “rulemaking process” is?]

There have been many articles written on this subject. I'm afraid if I try to summarize the ones I have it will be months more before I publish this. I'll just include this summary of a Fred Lucas article in cnsnews. Lucas debunks many of Obama's claims.

According to Obama, abortions would not be funded, but according to Lucas, the House bill mandates that government-run insurance exchanges provide at least one plan that covers abortion. Even if this interpretation is not correct, a number of amendments that would have specifically excluded abortion from government (taxpayer) subsidies have been rejected.

When asked if her amendment added to a Senate version of the bill would fund abortion , Senator Barbara Mikulski (D-Md) replied, “It would provide for any service deemed medically necessary or medically appropriate.” Apparently, all it would take is for a “doctor” to say carrying a child to full term would have adverse affects on the mother's mental and/or physical health and, regardless of how strong your religious beliefs may be against the unnecessary taking of a human life, you will be forced to be an accessory through your tax dollars.

Then there is the Obama claim that the “healthcare” plan will be “deficit neutral.” The Office of Management and Budget has estimated the bill and the bureaucratic monstrosity it creates will add over a trillion dollars to the budget over the next ten years. Since that estimate, OMB has reduced its projection to some 800-900 billion. Supposedly, this is due to some changes in a possible compromise bill.

But, not content to let one lie stand alone, it now claims a deficit reduction will occur. I think I recall a number in the 1 to 2 hundred million. If that's the case, then Congress should try to expand the bill to create a ten year cost in thousands of trillions of dollars. In ten years our national debt could be wiped out.

Back to reality. It is highly unlikely Obama plans to cut spending in other areas, so the only way to avoid added deficits to fund this outrageous program is to increase taxes. Obama said from the beginning of his campaign that he wanted change. I have said that his predecessors, Republican and Democrat alike, have stolen all of our dollars. Now Obama wants our to steal our change to fund his scheme.

Lucas points out that Obama claims of the number of uninsured Americans are overstated and gives evidence to support his contention. Interestingly, in a town meeting in Portsmouth NH in August, Obama said “nearly 46 million Americans don’t have health insurance coverage today,” but also said “46 million of our fellow citizens have no coverage.” Given that Obama, questions of birth certificates aside, said in Berlin that he is “a citizen of the world,” the two statements may not be synonomous.

Obama also claims that charges that illegal aliens will receive benefits are false and, in fact, the bill does exclude illegals, but attempts to introduce amendments to require verification of legal status have been rejected.

Obama also gave this half-truth to assure people that they would not have to change plans if they liked what they have: “If you like your doctor, you can keep your doctor,” Obama said. “If you like your private insurance plan, you can keep your plan. Period.” While it is true that the bill does not coerce change, Lucas says that it does provide incentives to employers to change their plans covering their employees. You can read the entire article at:

http://www.cnsnews.com/news/article/53695

Just a couple of more points: