Kennedy releases draft “health care reform” proposal

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The Senate Health, Education, Labor and Pensions Committee (HELP) has begun circulating what Senator Edward Kennedy (D-MA) calls a “draft of a draft.”

The proposal is called “the same old tired ideas we have fought against for many years” by Neil Trautwein, vice president of the National Retail Foundation, who is disappointed at the outcome of scores of hours of meeting with the committee (California Healthline 6/8/09).

Key points:

1. Guaranteed issue, community rating. This means guaranteed price increases. Supposedly this effect is overcome by forcing everybody to buy insurance. But the premiums are inevitably still higher for low-risk individuals than they would otherwise be. And now we have the Massachusetts experiment: The insurance mandate was supposed to drop premiums by 25% to 40%. Instead, they increased by7.4% in 2007, 8%-12% in 2008, and are expected to rise 9% this year, compared to an average nationwide increase of 5.7% over the same period. Annual health insurance costs the average family $4,000 per year more than the average American family (Michael D. Tanner, Cato 6/3/09).

2. Government-dictated “quality” standards. “Activities to improve health care quality” include mandatory incentives for case management, care coordination, chronic disease management, best clinical practices, evidence-based medicine, wellness and health promotion, culturally and linguistically appropriate care, etc. A Medical Advisory Council will be established by the Institute of Medicine and the Centers for Disease Control and Prevention to define best practices.

3. “Gateways” to “affordable health choices.” These new state bureaucracies resemble the Massachusetts Connector. Qualified individuals may buy certified insurance through the Gateway. Plans will have to meet many new federal requirements; and no state mandates will be abrogated. “Essential health care benefits” include such costly items as substance abuse, mental health, and rehabilitative services. Apparently, a maximum will be placed on the out-of-pocket limit—another way to guarantee increased costs.

4. Price controls and limits on balance billing. All Medicare providers will have to accept as payment in full the amount designated by an “affordable access plan.”

5. Cost of medical coverage depends on income. The proposal establishes income bands for out-of-pocket limits and for premium credits. This could mean that workers who increase their earnings could face the equivalent of a greater than 100% marginal tax on these earnings. “Premiums” would be a form of progressive taxation rather than an actuarially calculated premium.

6. Increased reporting requirements. To determine payments, subsidies, and compliance with mandatory purchase of acceptable coverage, individuals and other entities will have to make frequent reports to taxation authorities.

7. Coverage of non-citizens. Although plans will not pay for illegal aliens, they may have to pay for aliens who are lawfully present in the country. An amnesty program could instantly add millions of non-citizens to taxpayer-subsidized coverage.

8. “Shared responsibility” = individual and employer mandates. There will be as-yet-unspecified penalties for not having government-qualified coverage; that is, there are large numbers of blank spaces to be filled in with dollar amounts.

While the draft is heavy on regulations, reporting, and mandates, it contains no cost estimates or funding sources. Presumably, that is in the domain of the Senate Finance Committee.

Additional information:

Read the draft of the bill.

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8 Comments

  1. Looking over the thumbnail provided in your article, the single biggest concern I have is having the government form bodies to create ‘guidelines’. While am not as opposed to guidelines as some are, but I have always viewed them as just that. If we don’t take care of patient’s one at a time, over all quality will fail.

    It will not be a big jump for the government agencies to see guidelines as requirements. It certainly will create doctors that see only one way of doing things, thereby reducing individuality, independent-thinking and quality of care.

    Karl Marx maintained that by controlling the docs, the society is easier to control. We are all independent thinkers, even many who do everything by protocol.

  2. When I was in medical school I publicly debated one of Sen. Kennedy’s legal aides on the proposition “Health Care is a Right.” This man was positively vitriolic toward physicians. If Ted Kennedy’s name is on it, it is poison for physicians, as well as the public at large. This is about power: Power to take away our liberty, our sacred honor, our autonomy, our fortunes, even our very lives. If this becomes law, America will rapidly fall from its premier status as a medical mecca. I did not go to medical school to become a municipal employee. I want to work for my patients, not Ted Kennedy.

  3. Sen/Dr Tom Coburn was on 7AM C-SPAN call in program today, will likely be repeated later today..I want to tape it or take notes.
    He said (paraphrasing here) he is amazed at anyone thinking a government program can surpass private sector solution to any problem. Said lots of other great “pearls” so we should all memorize his talking points to recite with our Lib “friends.”
    Medicare will be lost in 2018, why do Grandparents, many retired for more years than they ever WORKED, want to make their own kids bankrupt? Another Selfish generation if you ask me!
    Government rationing means early DEATH for the oldsters, unless they LEAVE the USA..where do we go? Costa Rica? Argentina? Chile? Ireland? Bahamas?

  4. Physicians need to lower their costs and dependency, and stand up for themselves. There will be no rational reason to invest the time effort and pain to become a physician. Physicians’ lives will be filled with economic hardship, family difficulties, and emotional stress. Physicians in a position to stop this must do so. It is their responsibility.

  5. As physicians we need to convince everyone who will listen that regardless of the coverage scheme that evolves THE MONEY MUST BELONG TO THE PATIENT. No matter if an individual is covered by a governnment program or a private one that program will set a fee schedule for services.The patient must have the freedom to take that sum and apply it to services from the doctor of their choice.(This is exactly what does not happen with current government programs-medicare. The patient gets zero dollars if they dare to disobey the government and utilize the services of a physician who has opted out of medicare.)
    Talking points
    <Patients must have the freedom to chose their own doctor
    <The money must belong to the patient to allow them this freedom
    <Patients ARE capable of shopping for the best value in care(as determined by them, not by a participating provider list

  6. Libs are alway saying that this or that country with socialized medicine has a better health care system than we do in the United States.

    Have them name a Cancer then name ONE country with better five year survival rates for that Cancer than we have here.

    Then have them name ONE country where patients receive clot busting drugs in the Golden Hour after onset of chest pain more often than they do here. Have them name ONE country where patients receive revascularization quicker than we do here.

    Have them name ONE country where a patient can get in to see their doctor for an acute problem quicker than they can here. Have them name ONE country where patients have quicker access to specialists than we have here.

    They will respond that plenty of countries with socialized medicine have better infant mortality statistics than we have. What they won’t tell you is that those countries don’t include preemies in their infant mortality statistics. We count all live births hence our statistics are worse.

    Their statement on better health care is divorced from better outcomes or quicker access. The more socialized the care the higher the WHO score regardless of longer wait times, restricted access to specialty care and poorer outcomes.

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