The latest iteration of Democrats’ “health care reform” legislation, dubbed NancyCare, is the longest so far, 1990 pages. Basically it is the same as H.R. 3200.
Provisions can be broadly categorized by effect: tax increasing, cost increasing, choice decreasing, hassle increasing, wealth redistributing, and growth punishing.
It segments Americans into categories by economic status: families and individuals by income (as if income were a static characteristic), and business size by payroll and number of employees. Supposed affordability of premiums, level of responsibility for payments, and eligibility for subsidies (wealth transfers from others) vary according to which box one fits into.
The heaviest tax burden falls on those now considered wealthy, based on absolute income in dollars. The blended bill levies a 5.4% income tax surcharge on singles with an adjusted gross income greater than $500,000, i.e. a surcharge of $27,000 or more. These thresholds are not indexed for inflation, and could quickly move down the social scale.
Because of stepped, unindexed thresholds, businesses that expand, add an employee, or simply keep up with inflation could face a sharp increase in their “shared responsibility.”
Income levels qualifying for limits on premiums or out-of-pocket expenses are percentages of federal poverty level (FPL), which might change with the consumer price index, and the out-of-pocket expense limits are indexed for inflation.
The effect of the value of the dollar on this plan is critical. The 2009 federal deficit is greater than 40% of expenditures, and has thus crossed what some consider the tipping point for hyperinflation.
The word “penalty” occurs many times, especially regarding failure to report, or inaccurate reporting, of a vast array of information related to level of responsibility or compliance with requirements.
Academics will be pleased by the inclusion of their favorite panaceas, such as “coordinated care,” Accountable Care Organizations, quality measures, free preventive services, and community health centers—all of which cost money and may or may not produce future benefits.
Of course, there will be data collection on “health disparities,” on a broad set of population and subpopulation categories, in addition to segmentation by income.
Like previous versions, the bill enables the micromanagement of both insurance and medical services. The mind-numbing detail in the bill is just the beginning: the bureaucratic rules will follow.
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