Posts Tagged ‘Medicare’

Nancy Pelosi and Steny Hoyer

Speaker Pelosi speaks to media with Steny Hoyer watching

The smell of Obamacare is heavy in the air. So, here are a couple updates extracted from an AFP email:

There’s been much talk about ‘reconciliation’ but candidly, it’s overrated and perhaps even a red herring. Here’s why. The president will sign the original Senate bill, HR3590, into law immediately following House passage. That means BEFORE the Senate takes up reconciliation. A ruling last week from the Senate parliamentarian requires that to be the sequence. So by the time the Senate is debating reconciliation, they will be tweaking a disastrous bill that is already law.

So when you hear the president and others say the Senate will ‘continue to work on improving the bill in reconciliation,’ don’t be fooled.

With House passage of the Senate bill, Obama will have 99% of what he wants, whether or not he can get the other 1% through reconciliation. Winning the ‘reconciliation’ battle will certainly not ensure victory. We must win in the House.”

But, here’s a little bit of encouraging news:

Speaker Pelosi is crowing that she has the votes. But if she had the votes to pass her health care takeover, she would finish it now by holding the vote. No, the fact is for all the Speaker’s bluster and threats and deal-making, she does not yet have the majority needed to win.”

Let’s hope & pray the Blue Dogs and fence-sitters hold out and don’t give into the peer pressure they must be feeling from Obama, Pelosi, and the rest. (And that they can’t be bribed or lulled into thinking it ain’t so bad.) If you haven’t yet contacted your Congressman/woman to let them know you expect them to serve the will of the people and vote against Obamacare, now would be a good time.

In my original post titled “So, Republicans Don’t Have Any Better Ideas, Huh?“, I explained some of the healthcare reform ideas proposed by Congressmen Paul Ryan, R-WI, and Tom Price, R-GA. I also mentioned the “GOP Solutions for America” document given the President by John Boehner, R-OH. One of my readers reminded me that Sen. Judd Gregg, R-NH, had also presented a number of ideas on healthcare reform. Gregg isn’t always the most consistent conservative, but I decided it only fair to give his set of proposals, known as “Coverage, Prevention and Reform” (CPR), a look, too.

Sen. Judd Gregg

Sen. Judd Gregg of New Hampshire

Like his GOP colleagues, Sen. Gregg would like to start from scratch on crafting reform legislation. “There are a whole series of things that would improve the health care delivery system that both sides can agree on,” he said this week. “When the president said he was looking for ideas, I sent him some. I think all those ideas could be agreed on in a bipartisan way.” As per Holly Ramer, reporting for the Associated Press:

“Gregg’s plan… parallels some of the key ideas in the Democratic plans, but it is more aggressive in trying to control costs and less ambitious in extending the federal government’s role as an insurance regulator.

Similar to that the Democrats, Gregg’s plan would require everyone over 18 to carry at least basic coverage. And he would provide federal subsidies for households making up to three times the federal poverty level, or about $66,000 for a family of four.

The plan would be financed by taxing employer-sponsored coverage above certain limits. That’s a nonstarter for many Democrats, but economists say adopting such a policy would begin to push down health care spending, allowing for expanded coverage without busting the budget.

Gregg would also encourage employers to offer discounted premiums for workers who take steps to live healthy lives, and his plan shifts payments for hospitals and doctors to reward quality care rather than sheer volume of procedures and visits.

Though he would like to apply a projected $500 billion in 10-year Medicare savings to a Medicare solvency fund, Gregg said he would be willing to split the difference with Democrats, using $250 billion to shore up Medicare and using the rest to fund expanded health coverage.”

I’m not crazy about a couple things there (e.g., federally mandated insurance coverage), but overall I think Gregg has presented some interesting ideas. As yet, Sen. Gregg has not been invited to this week’s health care summit, but it’s possible that Senate Republican leader Mitch McConnell, R-KY, may ask Gregg to be part of the GOP delegation.

Newt Gingrich

Former Speaker of the House, Newt Gingrich

On another front, former Speaker Newt Gingrich has joined with Dr. John Goodman, President and CEO of the National Center for Policy Analysis (NCPA), to answer President Obama’s challenge for “better ideas”. In a recent article published in the Wall Street Journal, they presented their “Ten GOP Health Ideas for Obama” as the foundation for a patient-centered system. Here’s the (somewhat) condensed version:

1) Make insurance affordable. “…tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased…. choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.”

2) Make health insurance portable. “The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy.”

3) Meet the needs of the chronically ill. Educate & supply family caregivers. Facilitate more Health Savings Accounts (HSAs), as well as self-management of custodial services and medical care for the homebound disabled. Encourage providers to offer specialized plans for those with chronic diseases.

4) Allow doctors and patients to control costs. Doctors are typically not paid for well-care advice or consultations not given in person. They get paid for treating the sick, not preventative care. “[D]octors should have the freedom to repackage and reprice their services. And payment should take into account the quality of the care that is delivered.” (See my post “Convenient AND Affordable Healthcare?” about ‘concierge medicine’.)

5) Don’t cut Medicare. Obamacare would cut Medicare funding by roughly $500 billion. Sure, Medicare desperately needs fixing, but “cutting Medicare in order to create new unfunded liabilities for young people” won’t do it.

6) Protect early retirees. Need to a) allow employers to obtain individually owned insurance for their retirees at group rates; b) allow them to deposit some or all of the premium amount for post-retirement insurance into a retiree’s HSA; and c) give employers and younger employees the ability to save tax-free for retirement healthcare.

7) Inform consumers. The public should have access to (genericized) Medicare and government data about costs and quality of care before making their own healthcare decisions.

8) Eliminate junk lawsuits. The time for studies and tests is over. The federal government should follow the lead of states like Texas, which have already implemented effective civil justice reforms (e.g., caps on non-economic damages, loser pays laws, alternative dispute resolution, etc.).

9) Stop health-care fraud. Fight the $120 billion in annual healthcare fraud with “responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.”

10) Make medical breakthroughs accessible to patients. Cut bureaucratic red tape in FDA’s review process and implement quality-monitoring technology in the marketplace.

Sounds pretty darn sensible to me!

Yet, despite various Republican/conservative groups & individuals presenting their alternatives, the President still makes statements like, “The Republicans say that they’ve got a better way of doing it. So, I want them to put it on the table,” as he did at a recent campaign event for Sen. Reid. Either he has the memory-span of a goldfish, or he is intentionally misleading the public (via the MSM) to perpetuate the “no ideas” myth, or he will only consider such ideas “serious” if they are presented in 1000+ pages of detail. Somehow, I don’t think even that would be sufficient to get him to change his Big Government / big spending / nanny-state mindset.

Thursday, Feb. 25, 2010, is the date for the new “health care summit“, where President Obama requested to meet with Congressional Democrats and Republicans alike to, hopefully, make progress toward passing a healthcare overhaul bill. “We’re going to move forward the Democratic proposal — we hope the Republicans have one too,” Obama said. “And we’ll sit down and let’s hammer it out. We’ll go section by section. America can’t solve our economic problems unless we tackle some of these structural problems.”

But, what’s the point, really?

I don’t think I’m being cynical, here. It’s just that the plans are already in place to ram Obamacare through, regardless of what Republicans or the majority of The People have to say about it. The Democrats are sticking with what want, what they’ve got, and aren’t really interested in other ideas or approaches. Senate and House leaders (i.e., all Dems, remember) have been working for weeks on forging a compromise on their two versions of Obamacare. Early this week, the President will be revealing his own version of a healthcare reform bill, which will no doubt be a close reflection of what Pelosi, Reid, et al. are putting together. And it has been made clear that the Democrats are ready to use the reconciliation procedure to force through whatever they settle on — a highly questionable move, at best.

Republicans, on the other hand, generally don’t want anything to do with the current monstrosity, in any form. They want to start over, concentrating on smaller pieces of legislation, starting with those things both sides can agree on. For example, removing barriers to insurance coverage for people with existing medical conditions. They also want to do things like cap medical malpractice judgements, which the CBO says will reduce defensive medicine, thereby also reducing costs. (The President thinks such a cap would be “going too far”. Hmm. You don’t think his trial lawyer buddies are influencing his thinking, do you?)

So, why should Republicans even show up at the summit? Mainly, because not doing so will play right into their opponents hands, “proving” that they are unreasonable obstructionists who won’t even attempt to play ball. Plus, attending gives Republican leaders another chance to voice their alternative ideas in public, since the summit will be televised.

Despite this, IMHO, this week’s summit is really a sham. It’s an opportunity for the President to pretend he’s suddenly ready-n-willing to seriously consider what the Republicans are saying, encourage his fellow Democrats to stay firm in their quest to pass Obamacare, and get some good press. I seriously doubt much will really be accomplished toward “fixing” the current legislation, so that everyone is even partially satisfied. The Dems will still try to push through the travesty that is Obamacare via reconciliation, as planned.

Or, as Mark Tapscott of the San Francisco Examiner put it, “[T]he summit is part and parcel of a White House/congressional Democratic strategy to distract attention from what is about to happen on the Hill. It’s the classic magician’s trick of distracting you with the left hand while the right hand does the ‘trick.'”

For months now, the Democrats/liberals have been mocking Republicans/conservatives for having no ideas or solutions for healthcare reform or to address the energy issue or jobs & the economy, etc. (I pointed out in a previous post that this was baloney.) In his State of the Union Address, President Obama went on record again challenging the GOP for better alternatives. As Sarah Palin stated in her article “The Credibility Gap”,

He dared us to ‘let him know’ if we have a better health care plan, but he refused to allow Republicans in on the negotiations or consider any ideas for real free market and patient-centered reforms. We’ve been ‘letting him know’ our ideas for months from the town halls to the tea parties, but he isn’t interested in listening. Instead he keeps making the nonsensical claim that his massive trillion-dollar health care bill won’t increase the deficit.”

At RealClearMarkets, the Manhattan Institute’s Diana Furchtgott-Roth recently took a look at alternative healthcare proposals by two GOP members of the House of Representatives. Rep. Paul Ryan, R-WI, has reintroduced his “Road Map for America’s Future”, which includes a food stamps-like approach to healthcare reform. People would receive tax credits (low-income individuals would get extra) to purchase the insurance plan of their choice among those available in their state, and the insurers are free to price those plans according to the market. (All state-licensed plans would be eligible.) High-deductible/low-premium plans would be allowed for use with HSAs or more traditional managed care or fee-for-service plans, and special, government-subsidized high-risk plans would be available for those with chronic illnesses. No changes in Medicare for those currently 55 or older; when the rest of us turn 65, we “would receive $11,000, adjusted for inflation, to buy a Medicare certified plan. Those with lower incomes or with more serious health conditions would receive more funding.”

Republican Congressman Paul Ryan of Wisconsin

Rep. Paul Ryan (R-WI) (AP, via the Daily Caller)

According to the CBO, “national health expenditures would almost certainly be lower [under Ryan’s plan] than they would under the alternative fiscal scenario. Federal spending for health care would be substantially lower, relative to the amount in that scenario, for working-age people and the Medicare population.”

Rep. Tom Price, R-GA, is sponsoring the Empowering Patients First Act, H.R. 3400. Similar to Rep. Ryan’s proposal, under this plan people would be able to purchase health insurance with money from tax deductions. (If your employer provides health insurance, you can keep it.) States would subsidize high-risk pools for the chronically ill. Etc. Here’s an interesting innovation: Companies would be allowed (not required) to offer their employees a certain $ amount to pick-n-choose whatever plan they wanted on the open market, and that plan would be portable to their next job. Plus, the employer would retain the tax benefits it now receives for providing its workers with tax-free health coverage.

Federally-controlled public utility w/ mandated coverages VS. All Americans (even w/ special needs) able to buy whatever plan they want on the open market. I know which one I prefer….

In an attempt at bipartisan communication and reconciliation, President Obama joined “the opposition” at the House Republicans’ Annual Meeting in Baltimore last night (1/29/2010). Before the President took the stage, Republican Leader John Boehner, R-OH, presented him with a compilation of Republican policy alternatives for healthcare reform, energy crisis/independence, jobs, the budget, and housing. These were not brand new proposals but had been created and presented in Congress over the past year. Want to read them for yourself? Visit GOP Solutions for America.

President Obama, are you listening? (Reading? Paying attention and giving serious thought?) I hope so.

For the past couple of days, Ricardo Alonso-Zaldivar and Erica Werner have been reporting via the Associated Press on what happened in the first round of Senate votes on the “final” health care reform bill. Not surprisingly, the Democrats are getting pretty much what they want,… so far.

On Thursday, an amendment by Sen. Barbara Mikulski, D-MD, and Olympia Snowe, R-ME, focusing on women’s health issues, passed 61-39. Republicans voiced concerns that the provision gave the HHS secretary “authority to require health plans to cover additional preventive services for women. The Congressional Budget Office said the amendment would cost $940 million over a decade.” Sen. John McCain, R-AZ, introduced an amendment that would have stripped out over $400 billion in cuts to projected Medicare spending, but it was narrowly defeated, 58-42 (with 60 votes needed to pass anything). For what it’s worth, an amendment sponsored by Michael Bennet, D-CO, was unanimously approved, ensuring that no current, legally-guaranteed benefits in traditional Medicare will be cut by the reform legislation.

AP - Senators Lieberman, Collins, & Specter

On Friday, Republicans tried to take out the Community Living Assistance Services and Supports (CLASS) Act from the bill. This is a long-term care insurance program long championed by the late Sen. Ted Kennedy, D-MA, and designed to assist the disabled and seniors. A few Democrats — notably including Max Baucus, D-MT, and Kent Conrad, D-ND — joined their colleagues across the aisle in opposing the program, citing budget concerns. But, the program stayed in with a 51-47 vote. Republicans also attempted to reinstate $120 billion scheduled to be cut from Medicare Advantage, but they were defeated in a 57-41 vote.

Sen. Harry Reid

V.P. Biden before an audience

Besides the specific votes themselves, the other important takeaway here is that Senate Majority Leader Harry Reid, D-NV, still can’t get a firm 60 votes needed for a filibuster-proof majority. The problem members are moderates like Ben Nelson, D-NE, and Joe Lieberman, I-CT. The problem issues are abortion coverage and a government-run insurance plan (aka the “public option”). Of course, a few are also blaming delays on Republicans. Sen. Dick Durbin, D-IL, told reporters, “Republicans are not being forthcoming in either allowing us to vote on our own amendments or in offering their own.” I suspect not only is Sen. Durbin wrong, but he needs to quit whining and concentrate on the internal divisions within his own party.

In a rare Saturday session, Republicans offered their third amendment in as many days — this one sponsored by Sen. Mike Johanns, R-NE. The measure would have “eliminated $42 billion in cuts over 10 years to agencies that provide home health care to seniors under Medicare,” but it was defeated in a 53-41 vote, despite support from four moderate Democrats. These are politically risky votes, especially for those like Blanche Lincoln, D-AR, who are facing a difficult re-election year. There was a lot of intense discussion among Democrats to come up with a government-run insurance plan acceptable to all.

And, there was a lot of heated argument between Dems & Reps about who is really looking out for the best interests of seniors. “These are truly some of the most vulnerable Americans that receive these [home health care] services and the cuts are placed directly on their backs,” Johanns said. Democrats, on the other hand, maintain that the proposed cuts “would reduce overpayments, inefficiency and waste in the popular program, thereby strengthening it.” Sen. John Kerry, D-MA, then offered an amendment to protect those home health benefits that are currently guaranteed, which passed unanimously (96-0).

One final comment… Let’s assume that Harry Reid & Co. finally agree to remove all government-funded abortion from the bill, thereby getting the vote of pro-life Democrats like Nelson. Let’s also assume that, somehow, they are convinced to take out the “public option”, thus gaining votes from hold-outs like Lieberman. While these might be seen as “victories”, Republicans and conservatives should not celebrate for long. First, as long as Lefties like Reid, Pelosi, & Obama are in the majority, they will keep pushing to get abortion coverage and a “public option” in place some way, somehow. Second, there is a whole LOT more to the current Obamacare bill that is cause for deep concern — e.g., HUGE costs resulting in increased federal deficit and increased taxes for us taxpayers, greatly increased insurance costs, increased governmental interference in private family matters, forced unionism of healthcare professionals (giving unions more money & influence), reduced compensation for healthcare professionals, reduced options and rationed care for all (including poor, disabled, & elderly), etc. Americans must continue to fight against Obamacare in all combinations and forms.

UPDATE: How does the most recently unveiled health care proposal, presented by Max Baucus, D-MT, and the Senate Finance Committee, compare? Very similar, in fact. Here is what Senator Jon Kyl, R-AZ, said on the 9/16/2009 Hugh Hewitt radio show: “It provides for a government takeover of health care…. [I]f you take the true costs, it’s over a trillion dollars. It will cut Medicare significantly, hurting care for seniors. It’ll mandate that everybody in America have insurance, as defined by the federal government. It will raise a lot of taxes in order to pay for that insurance for people who can’t afford it. And it will set up a regulatory regime for all insurance which will end up with government-run insurance. Now, that’s to be distinguished from a government health care plan, or a government-run insurance company. They call that a ‘co-op’, and there’s that in here, too. But, that’s different from running health care. And, at the end of the day, this bill puts Washington in charge of all health care in America….” Of course, Kyl was only addressing some of the provisions of the Senate bill, but it sounds awfully familiar to me.

UPDATE 2: Yes! The “public option” has been soundly defeated – by members of both parties – in the Senate. But, this is not the end. And there is still plenty to object to in the Democrat-proposed bills. The drama continues….

UPDATE 3: 10/11/2009: Democrats in both the House and the Senate have been hard at work the past few days, crafting new versions of their various health care bills. Of course, it’s all “behind closed doors”. What can we expect? Read this article about the “Secret Plan”. (Yeah, I know it sounds kinda hokey, paranoid, conspiratorial. But this investigation is by some very well-respected journalists & researchers.)

One last thing. Many Left-leaning people like to say that Republicans are “the party of NO” and that conservatives in general are just whiners and complainers with no real solutions of their own. Well, that just isn’t the case. Granted, some of our leaders on the Right don’t always get their “stuff” together as soon as I would like. But there are, indeed, conservative Senators, Representatives, Governors, etc., who are putting out good ideas to address various political & cultural issues. They are backed up by solid research by respected think tanks like the Heritage Foundation, the National Center for Policy Analysis (NCPA), American Solutions, and the Center for Health Transformation.

Go here for some examples of Health Care Solutions from the Right side of the aisle.

Then, if you haven’t already done so, go to Free Our Health Care NOW! to see what you can do to take action!

Abortion-funding: As usual, there are mixed signals on whether or not the proposed legislation will provide for government-funded abortions. The White House has not said much about this of late. But, in a 2007 speech to Planned Parenthood, Obama said “reproductive care is essential care. It is basic care. And so it is at the center, the heart of the plan that I propose.” He went on to indicate that any private insurers must “abide by the same rules in terms of providing comprehensive care, including reproductive care” in order to receive federal subsidies. In other words, elective abortion will be included in the “essential benefits” mandated by the government.

What does H.R. 3200 say about abortion? Both sides acknowledge that elective abortion is indeed covered via the “public option” proposed by this bill. The debate is whether federal money would be used. The recently passed Capps Amendment is supposed to allow only those types of abortions covered by the Hyde Amendment (see below) and to limit payments for said abortions to that amount contributed by the insured and/or their employer, thereby leaving federal subsidies (aka “affordability credits”) untouched. But even some conservative Democrats are pointing out that, under a “public plan” where the government is the “single payer”, all payments – including for abortions – come from a federal account.

So, whether on a “public plan” (by choice or otherwise) or a private plan, a pro-lifer will end up helping to finance abortions. Once those premiums are paid into “the pot”, the insured has no say in what those funds are used for. And in the case of the “public plan”, it all effectively becomes federal money and every procedure is financed by a federal agency according to federal statutes and regulations.

What about the Hyde Amendment, which prevents Medicaid funds from being used for abortions, except for cases involving incest, rape, or to save the mother’s life? While the President has said that there are no plans to change it, the fact is that the Hyde Amendment is an addition to the annual Health and Human Services Department appropriations bill, so Congress can vote to modify or reverse it at any time. More to the point, funding received for Obamacare would not go through the HHS, so any restrictions covered by Hyde or anything else would be irrelevant.

When speaking to general or right-leaning audiences, Democrats assure us there are no abortion-funding provisions in the bill. But amongst themselves, they assure fellow liberals that “abortion will be covered by one or more of the health care plans available to Americans.” (Zoe Lofgren, D-CA). Finally, on July 30, 2009, House Democrats voted out an amendment that would have explicitly forbidden federal funds from being used to pay for abortions. That says a lot. (Notably, that same day they killed another amendment that would have prevented illegal aliens from getting government-funded health care.)

Is it any wonder that those who promote the sanctity of human life are very troubled by this scenario?

Every one of the issues examined here certainly sound like legitimate concerns about the effects of Obamacare to me. People are just plain scared, worried, and angry with Democrats and Left-wingers for trying to pass such things through the legislature, let alone trying to “shove this down our throats.” Even if you disagree on some points, can you really blame them?

Impact on doctors: There are three major points to consider here. First, America already has a shortage of doctors, particularly primary-care and family practice physicians. Even doctors are advising their own children to go into another profession. One of the biggest reasons for this has been the outrageous costs of malpractice insurance – in many cases $30,000/yr or more for generalists, $70,000-150,000 (or more) for many specialists – to help guard against lawsuits in an increasingly litigious society. As much as 25% of the money paid for health care is spent on ‘defensive’ medicine and documentation, which also takes up a lot of a doctor’s time. Unfortunately, there is no medical liability reform (aka ‘tort reform’) included in the Obamacare legislation to alleviate this. (By the way, some states have successfully reformed their tort systems, like Texas and Indiana, so there are workable ways to do this.)

The second point is that, under the proposed legislation, doctors will be paid much less. Currently, insurers decide (or negotiate) what percentage of full price they will reimburse a hospital, physician, pharmacist, or other health care professional for a particular drug, procedure, examination, test, or consultation. Such rates are typically about 50-80%. Put another way, the doctor must write off roughly 20-50% of the “list” fee (i.e., what someone without any insurance would pay). When your overhead already runs 60-70% of revenues, that really eats into your income, as well as the viability of your practice. In a 2008 survey conducted by The Physicians’ Foundation, 82% said that if proposed cuts to Medicare reimbursements went through, their practices would no longer be sustainable. But, it gets worse….

For programs like Medicare and Medicaid, the government unilaterally decides how much they will pay – typically 60-80%, but sometimes as low as 20%. In the TPF survey, 36% said Medicare reimbursements were less than their cost of providing care and 65% said Medicaid reimbursed less than their cost. (This is why many doctors are reluctant to take very many patients on government programs. Some simply don’t take them.) Plus, most managed care plans tie their reimbursements to Medicare’s fees, often paying providers just 20-30% more than Medicare does. Under Obamacare, the “public plan” would reimburse only about 5% more than the Medicare rates. The more people get put on this government-controlled insurance, the less doctors will be earning. Thus, one of the major incentives to go into, or remain in, medicine will erode away. (Especially when one considers the high debts one must pay off at the beginning of a medical career and the enormous insurance rates, overhead, etc., throughout one’s career.)

Here is an excerpt from a blog post by a board certified, private practice oncologist, that gives an excellent “insider’s view”.:

It’s quite simple, really: very hard work, and declining income. Private practice physicians have seen a fall of approximately 30% since 2004. Worsening economics are right around the corner. Given the extraordinary expense of chemotherapy and supportive therapies, combined with reimbursements that just exceed a wash, it will become impossible to deliver outpatient care in more than half the venues in the United States quite soon. And then, simply put, the senior physicians will quit….

Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They’ll scarcely need to ration care: there just won’t be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.

Is it any wonder that a cash-only system is being adopted by more and more medical practices? Not having to deal with insurance claims and related paperwork saves time and money. Will this even be an option in an era of government-mandated, government-structured health insurance?

In addition, the President has already been asking Congress to grant the Executive Branch – in the guise of an ‘independent’ advisory board – more power to recommend (dictate?) Medicare reimbursement rate modifications. These rates now vary from region to region, where local legislators often help decide what they will be. The proposed new board would end this practice, handing more control to the federal government.

Thirdly, there is a development that is only just now coming to light. When you think of people who belong to unions, you don’t usually think of doctors and other medical professionals. (Well, maybe nurses.) But, that may change. It seems some congressional friends of Big Labor slipped some “last minute” provisions in the proposed bill that will force hundreds of thousands of physicians, surgeons, and other health care workers to unionize. This will mean millions (billions?) of dollars in new union dues going to union war chests, to be spent on new bureaucracies to influence health care policies and negotiations, more corruption, and financing of the Big Labor political agenda. (Of course, unions will get favored treatment under the legislation, but not necessarily in the better interests of the average union member.) And if you object to Obamacare and/or compulsory unionization, you may find yourself on the wrong end of intimidation and other strongarm tactics of persuasion. (Just ask Kenneth Gladney, who recently spent a couple days in the hospital recuperating from a harsh beating at the hands of union thugs, when they found him handing out anti-Obamacare “Don’t Tread On Me” flags.)

So,… Obamacare is supposed to cover millions more people, but it does nothing to encourage people to go into medicine. Instead, it will cut costs by underpaying hospitals and physicians for their services. Plus, it will force health care professionals to unionize, thereby inserting more bureaucracy, corruption, control, and unnecessary expenditures into the mix. (Can we afford to have our doctors pressured or ordered to go on strike?) Hmmm. If, at the very least, you don’t see long waits and decreased quality of care in our future, you’re just not paying attention.

< to be continued… >

Impact on private insurers: The first impact is the just-discussed fact that those who offer private insurance plans will be subject to additional federal regulations. Some of these might be good (e.g., disallowing exclusion due to a “pre-existing condition” or cutting off coverage when you get too sick) and some will border on the ridiculous (see above re maternity benefits for childless, single men). Regardless, insurance companies will be doing a lot of adjustments and reassessments of their costs and risks. Some will decide to get out of health care completely.

What about competition? Proponents of the proposed health care overhaul contend that it will provide a “public health insurance option that would compete with private insurers within the Health Insurance Exchange – giving consumers more choices, keeping insurance companies honest and increasing competition.” The first question is whether or not private insurers need more competition. There are currently 1300+ such companies in the U.S., but it is state regulatory legislation (allowed by Congress under the interstate commerce clause, somehow) that prevents them from all competing in every state. At least one state has purportedly allowed only 6 private insurers to cater to its residents. There are examples where one or two big insurers dominate 80% or so of a state’s market. So, there is definitely a problem here, but adding another, government-run bureaucracy into the mix is not the answer. The better solution is to change the law(s) to allow every insurance company to compete in every state. If this does not happen, and the overhaul is enacted, then the “public option” immediately has the unfair, competitive advantage of being the only insurer available in every state.

Furthermore, it is very likely that a majority of businesses will drop health insurance from their employee benefits, because the new, federally-imposed fine for doing so (8% of payroll) will be less than the cost of purchasing coverage that complies with the new standards and minimums. One estimate by the non-partisan Lewin Group is that up to 119 million employees will end up in the “public plan”. State and federal workers will likely be the first to get kicked into the “public plan” – except for our leaders in Congress, the White House, or SCOTUS, of course –, along with union members, because health care is such a huge expense for governments and unions. (This is because the employees in question have been given such great benefits for decades, and there are so many of them, both active and retired.)

This means that, in order to retain or win back those employees (and pensioners) as customers, the private insurers will have to compete against a “public option” that has the full weight and purchasing power of the federal government behind it and, if we are realistic, will be subsidized with taxpayer money. It will be able to set its own reimbursement rates, as Medicare and Medicaid currently do. As I recall, government entities do not pay taxes, either. Finally, there is some question as to whether people will be able to file suit against the “public plan”/government. In a private insurance system, if you do not like the way a matter is handled or you are a victim of wrongful denial of insurance, you can either switch insurance companies or sue. In a government-run, single-payer system, neither option is available. And that is exactly what this will eventually lead to, even if it starts out as a “co-op”.

Bottom line here is that, in their less guarded moments, the Democratic leadership have admitted they are pushing for a single-payer system (see “Trojan Horse” article here), because they want to drive private insurers out of business and have the American people totally dependent on the federal government for their health care. (Socialism, here we come.) Of course, some private plans may indeed be able to survive under these conditions by offering better coverage and better access to providers, but not for long, if the Left has its way. Either way you look at it, this will result in a lot of ruined businesses and unemployed insurance professionals.

< to be continued… >

These seem like pretty valid concerns to me. Let’s look at a few more issues brought up by Obamacare’s critics:

Less coverage: In addition to the above-mentioned home care and wellness services provided by Medicare Advantage, it covers several other things not covered by basic Medicare – e.g., improved prescription drug plans, screening for vision and hearing, dental care. Many seniors opt for Medicare Advantage because it is cheaper than getting private supplemental coverage. This goes for the disabled, as well as those of low income and rural residents, too. Without MA, many will no longer be able to afford such coverage and will have to do without, thereby putting their health at risk.

What about the President’s promise that, if you like your doctor and your insurance, you can keep them? Frankly, he has no business saying such a thing. For one, your employer can decide to change or drop your insurance right now. Or, your doctor can decide not to accept whatever plan you are on. Second, while there are no mandates in the current bill forcing such changes, it is the outworking of the proposals and their consequences that will, in effect, limit what kind of policies you can get and the doctors you can see.

On second thought, I need to amend that “second” statement. There will be no forced changes right away. Most employer-funded plans would need to be modified to meet new, H.H.S.-determined “minimum benefit standards”, but they would have a 5-year grace period to do so. This could mean dropping benefits in some areas, so that they can include other, newly-mandated coverage. Some may lay off workers so they can afford health insurance for the rest. They would be able to choose a level of coverage and give employees the ability to shop for a new plan at the marketplace called the Health Insurance Exchange. Or, they might just decide to stop providing health insurance altogether. (More on this to follow.)

Privately-obtained insurance policies, however, will supposedly not be required to comply with the federal minimums. Or, will they? Given what I have read about the “essential benefit package” to be designed by the new Health Benefits Advisory Committee, I am not so sure any private insurance policies will escape federal dictates. Of course, everyone will be mandated to get some sort of health insurance coverage, or they will be subject to a fine – starting at $750/yr for an individual and ranging from $1500/yr to $3800/yr for a family. And, by the way, there will be a new tax on those who obtain private insurance. Yippee!

< to be continued… >