Let's discuss what's in the Health Care Bill

UI should preface this in that I am very well educated on Medicare Part D:


On page 355 of the bill that talk about eliminating the "doughnut hole" coverage gap in the Part D prescription Drug program for Medicare by gradually increasing the initial coverage limit and decreasing the total out of pocket costs over about 8 years. While that sounds great, it's HUGELY expensive. There would have been no doughnut hole in the original legislation if it was feasible. Even by having Drug companies offer brand name drugs at a 50% discount won't help, they will just raise drug prices for the rest of Americans to cover that hit they will take.

I honestly don't see how we can even do this tweak to Part D, let alone all the other modifications in this healthcare proposal and see any cost savings.

Medicare Part D was a huge entitlement program even with the doughnut hole. Premiums will necessarily go up if the hole is eliminated or companies will drop out of the program. The companies are there to make a profit. In the first year of Part D, there were plans that eliminated the doughnut hole for people willing to pay a much higher premium. It was a great plan for those consumers with huge drug bills, but not so for the insurance companies. Even with that higher premium, the insurance companies LOST money on those plans, which they eliminated the following year. Now I know no one will cry a tear for insurance companies, but they tried to do this (eliminate the doughnut hole) and it just wasn't economically feasible for them to do it.

As, I have stated, I am pretty well versed in Medicare Part D, it will be pretty hard, if not impossible, to improve it and keep it costing the same. If Medicare were to regulate prices of drugs by their buying power, that would probably be the best route to reduce costs to Seniors. That's a double edged sword though, if drug companies make less money, that means less money to research more new drugs.

reply to post by Jenna


Actually that is what a lot of people I talked to were talking about doing, and if I owned my own company a way I thought to get around it.

Fire everyone but then hire them back as "sub-contractors" That way your only "employing" a few amount of people that makes you exempt from the size of business that qualifies to receive the penalty.

So it wouldn't surprise me if that is what that clause means.

Well, it seems that the MODs aren't going to help with updating the OPs, so here is a list of hotlinks to the specific claims in the OP & their research/discussion posts in the thread

PG 22 MANDATES the Government will audit books of ALL EMPLOYERS that self insure!!

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PG 24 Line 116 Government effectively sets prices for ALL private health plans.

2

PG 30 Line 123 THERE WILL BE A Government COMMITTEE that decides what treatments/benefits you get.

PG 37 Line 132 The Government will be reviewing grievances about themselves and will decide on appeals for rejected claims.

PG 29 Line 4-16 YOUR HEALTHCARE IS RATIONED!!! Additionally you can reference PG 15 Line 19-25.

PG 42 The Health Choices Commissioner will choose your HealthCare Benefits for you. You have no choice!

PG 50 Line 152 HealthCare will be provided to ALL non US citizens, illegal or otherwise.

PG 58 Government will have real-time access to individuals’ finances & a National ID HealthCare Card will be issued!

PG 59 Line 21-24 Government will have direct access to your banks accounts for electronic funds transfer!

PG 61 Line 22-24 Congress has no clue what Electronic Medical Records will cost. Asks for estimate.

PG 62 Protection of Data, Government shows they will have database of your personal & financial info.

OK peeps a big one – PG 64 Line 21-25, pg65 Line 1-5 which refers to processing payment transactions by financial institutions

PG 65 Line 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (ACORN).

PG 72 Line 8-14 Government is creating an HealthCare Exchange to bring private HealthCare plans under Government control.

PG 84 Line 203 Government mandates ALL benefit packages for private. HealthCare plans in the Exchange.

PG 85 Line 7 Specs for of Benefit Levels for Plans = The Government will ration your HealthCare! #AARP members – your Health care Will be rationed.

PG 89 Line 6-10 The FAR is not applicable. Government can write contracts any way they want.

PG 95 Line 8-18 The Government will use groups i.e., ACORN & Americorps to sign up individuals for Government HealthCare plan.

PG 98 Line 8 Americans - You will be paying for others HealthCare while paying for your own.

PG 100 Line 15-19 The Government Will be using ACORN and other community groups to promote & enroll.

PG 102 Line 12-18 Medicaid Eligible Individual will be automatically enrolled in Medicaid. No choice.

PG 109 Line 207 Health Trust Fund. The Government will raise taxes on EVERYONE to fund HealthCare as they see fit. Correction

PG 110 Line 7-12 Employment taxes on ALL employers NOT offering Government HealthCare. No choice.

PG 110 Line 13-18 An excise tax on ALL goods from companies not offering Government HealthCare. ALL Americans pay.

PG 110 Line 19-24 the Treasury can take $$ from Soc Line to pay HealthCare.

PG 111 Line 208 The Federal Government will usurp all State powers in State Based HealthCare Exchange. Violation of 10th Amend.

PG 119 Line 1-3 Establish geographically-adjusted premium rates for public option Can you say ACORN census?

PG 121 Line 223 PAYMENT RATES FOR ITEMS AND SERVICES. Can you say Government price fixing & monopoly?

PG 124 Line 24-25 No company can sue Government on price fixing. No “judicial review” against Government Monopoly.

PG 126 Line 10-15 The Government can make up prices for anything at anytime for any reason.

PG 126 Line 22-25 Employers MUST pay for HealthCare for part time employees AND their families.

PG 129 The public option will be subsidized. Credits = your tax dollars. Redistribution of wealth

PG 127 Line 1-16 Doctors: The Government will tell YOU what you can make.

PG 130 Line 10-23 Federal Government will subsidize State Medicaid = Even Higher State & Federal taxes for ALL.

PG 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE.

PG 149 Line 16-24 ANY Employer with payroll 400k & above who does not provide public option pays 8% tax on all payroll.

PG 150 Line 9-13 Biz with payroll btw 251k & 400k who doesn’t provide public option pays 2-6% tax on all payroll.

PG 151 Line 1-3 Aggregate Rules-tax on employers payroll not on public option include payroll of other biz.

PG 167 Line 18-23 ANY individual who doesn’t have acceptable HealthCare according to Government will be taxed 2.5% of inc.

PG 170 Line 1-3 Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay)

PG 195 Officers & employees of HealthCare Administration (Government) will have access to ALL Americans financial/personal records.

PG 198 Line 1-3 1.5% ADDITIONAL TAX on peeps who have income of 500k to 1mil. Redistribution of Wealth.

PG 198 Line 4-6 5.4% ADDITIONAL TAX on peeps who have income of $1mil+. Redistribution of Wealth

PG 199 Line 1-4 Surtax rates on raised AGAIN on Americans in 2012.

PG 201 Line 12-19 Government will ignore whatever costs they see fit to show savings. (Cooking the books)

PG 203 Line 14-15 “The tax imposed under this section shall not be treated as tax” Yes, it says that.

PG 202-215 is a Government rewrite of the tax code ensuring more taxes for EVERYONE, Everywhere.

PG 241 Line 6-8 Doctors, doesn’t matter what specialty you have, you’ll all be paid the same.

PG 236 Line 22-25 PG 237 Line 1-3 National rate of uninsured defined by Census. Can you say ACORN corruption?

PG 239 Line 14-24 Government will reduce physician services for Medicaid. Seniors, low income, poor affected.

PG 253 Line 10-18 Government sets value of Dr’s time, prof judg, etc. Literally value of humans. We’re next.

PG 239 Line 10-12 Medicare DSH payments will be increased. Can you say even higher taxes for all?

PG 238-249 Line 1121 Doctors-Government mandates your growth, costs, value, services, & income. Peeps- Welcome to rationing

PG 260 Line 1125 Fed Government will adjust Medicare Payment Localities for California based on Census. ACORN?

PG 265 Line 1131 Government mandates & controls productivity for private HealthCare industries.
PG 268 Line 1141 Fed Government regulates rental & purchase of power driven wheelchairs.

PG 272 Line 1145 TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!

PG 270 Line 1144 Government Mandates that all private ambulatory surgical centers submit cost data & other data

PG 276 Line 3-20 Oxygen Equipment & Supply Companies - Government MANDATES you will provide supplies NO MATTER where individual is.

PG 287 Line 14-25 PROOF that Government will ration HealthCare by mandating waiting periods for readmission.

PG 298 Line 9-11 Drs, treat a patient during initial admission that results in a readmission - Government will penalize you.

PG 303 Line 12-25 Post Acute Care Services Data – Government will collect data including personal information as they see fit.

PG 304 Line 17-19 BIG ONE HERE: Expedited Data Collection – More information here

PG 304 Line 17-19 Government does NOT have to protect your private, share with anyone, & is not resp (more on expedited data collection)

PG 306 Line 3-6 The Government can expand the scope & size of Post Acute Program Services anytime & as they see fit.

PG 313 Line 9-14 Government MANDATES Health Services providers will state ownership, invest, & compensation arrangements.

PG 317 Line 13-20 PROHIBITION on ownership/investment. Government tells Drs. what/how much they can own.

PG 317-318 Line 21-25,1-3 PROHIBITION on expansion- Government is mandating hospitals cannot expand.

PG 318-319 Government is mandating how hospitals & physicians conduct business & investments. We’re next!

PG 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!!

PG 328 Line 1157 Government study disguised. Its a HealthCare workforce study mandated by law for unionization.

Pg335 Line 16-25 PG 336-339 Government mandates estab. of outcome based measures. HealthCare the way they want. Rationing.

PG 341 Line 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc. Forcing peeps in to Government plan.

PG 354 Line 1177 Government will RESTRICT enrollment of Special needs people!

PG 355-369 Line 1181 Government disguises tax on Drug Companies as rebate to Government to subsidize Drugs. We pay in the end.

PG 379 Line 1191 Government creates more bureaucracy – Telehealth Advisory Committee. Can you say HealthCare by phone?

PG 399 If your a subsidy eligible individual under Medicare part D and you don’t enroll, the Government will auto enroll you.

PG 401 Section 1221 Americans will fund Medicare Language & Translation Services Program. Can you say MORE taxes?

PG 404 Lines 12-16 Government exempts itself again from - Chap 35 of title 44, USC including privacy of Americans.

PG 404 Lines 17-19 Government doesn’t know the cost of Language services but states that money is there.

PG 425 Lines 4-12 Government mandates Advance Care Planning Consult. Think Senior Citizens end of life.

2

PG 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of atty. Mandatory!

2

PG 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in death.

2

PG 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.

PG 429 Lines 1-9 An “advance care planning consultant” will be used frequently as patients health deteriorates.

PG 429 Lines 10-12 “advance care consultation” may include an ORDER for end of life plans. AN ORDER from Government.

PG 429 Lines 13-25 The Government will specify which Doctors can write an end of life order. Logan’s Run anyone?

PG 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.

PG 432 Lines 18-21 The Government will publish “quality measures” for individual’s end of life in Federal Register.

PG 434 Section 1234 Military Active, Reservists, Families - If you’re not enrolled in Tricare it is mandated.

PG 434 Section 1234 Military Active, Reservists, Families - Once HealthCare bill is passed your premiums will go up.

PG 438 Section 1236 The Government will develop a patient decision making aid program that you & Dr. WILL use.

PG 443 Lines 7-24 Government at taxpayers expense test out an “Accountable Care Org” program (Government doesn’t have plan.)

PG 444 Lines 1-6 Government’s Accountable Care Program will mandate services & infrastructure thru reward/penalty system.

PG 448 Lines 4-17 Government will set performance targets for ALL Accountable Care Organizations including private.

PG 455 Lines 3-4 Government exempts itself from Chapter 35, Title 44 Paperwork Reduction & Citizens Privacy Protection Act

PG 460 Section 1302 Knock, Knock - It’s the Government and I’m here with the Medical Home Program - YOUR home

PG 460 Section 1302 The Government WILL provide medical services in your home. Paging Nurse Pelosi!!

PG 464 Lines 17-22 Independent Patient Center Home Medical Services - Drs. don’t have to be at your home just some directed by D

PG 469 Community Based Home Medical Services=Non profit organizations. Hello, ACORN Medical Services here!!?

Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED Organization - 1 monthly payment to a community-based organization Like ACORN?

PG 476 19-20 Chapter 35/ title 44, (Privacy of personal records) shall not apply Home Medical Services. ACORN ACCESS

PG 489 Section 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into your marriage.

[edit on 8/10/09 by redhatty]

PG 494-498 Government will cover Mental Health Services including defining, creating, rationing those services.

PG 502 Section 1181 Center for Comparative Effectiveness Research Established. - Hello Big Brother - Literally.

PG 502 Line 5-18 Government builds the “Center” to conduct, support, & synthesize research to define our HealthCare Services.

PG 503 Line 13-19 Government will build registries and data networks from YOUR electronic medical records.

PG 503 Line 21-25 Government may secure data directly from any department or agency of the US including your data.

PG 504 Line 6-10 The “Center” will collect data both published & unpublished (that means public & your private info)

Refer to this post

PG 506 Line 19-21 The Center will recommend policies that would allow for public access of data

PG 518 Line 21-25 The Commission will have input from HealthCare consumer reps - Can you say unions & ACORN?

PG 524 18-22 Comparative Effectiveness Research Trust Fund set up. More taxes for ALL.

PG 525-620 deals with the Government basically taking over nursing homes, ... Read More here

PG 620 Line 1-9 The Government will define, prioritize, and nationalize your Health Care Services.

PG 621 Lines 20-25 Government will define what Quality means in HealthCare. Since when does Government know about quality?

PG 622 Lines 2-9 To pay for the quality Standards Government will transfer $$ from to other Government Trust Funds. More Taxes.

PG 624 “Quality” measures shall be designed to assess outcomes & functional status of patients.

PG 628 Section 1443 Government will give “Multi-Stake Holders” Pre-Rule Making input into Selection of “Quality” Measures.

PG 630 9-24/631 1-9 Those Multi-stake holder groups including Unions & groups like ACORN deciding HealthCare quality.

PG 632 Lines 14-25 The Government may implement any “Quality measure” of HealthCare Services as they see fit.

PG 633 14-25/ 634 1-9 The Secretary may issue non-endorsed “Quality Measures” for Physician Services & Dialysis Services.

PG 635 - 653 Physicians Payments Sunshine Provision - Government wants to shine sunlight on Docs but not Government.

PG 654-659 Public Reporting on Health Care-Associated Infections - Looks okay.

PG 660-671 Doctors in Residency - Government will tell you where your residency will be, thus where you’ll live.

PG 676-686 Government will regulate hospitals in EVERY aspect of residency programs, including teaching hospitals.

PG 686-700 Increased Funding to Fight Waste, Fraud, and Abuse. LMAO!! You mean the Government with an $18 mil website?

PGs 701-704 Section 1619 If your part of HealthCare plan that isn’t in Government HealthCare Exchange but you qualify for Federal aid, no payment.

PG 705-709 SEC. 1128 If Secretary gets complaints (ACORN) on HealthCare provider or supplier, Government can do background check.

PG 711 Lines 8-14 The Secretary has broad powers to deny HealthCare providers/suppliers admittance into HealthCare Exchange.

Pg 719-720 Section 1637 ANY Doctor who orders durable medical equipment or home medical services MUST be enrolled in Medicare.

PG 722 Section 1639 Government MANDATES Doctors must have face-to-face with patient to certify patient for Home Health Services.

PG 724 Lines 16-22 Government reserves right to apply face-to-face certification for patient to ANY other HealthCare service.

PG 724 23-25 PG 725 1-5 The same Government certifications will apply to medicaid & CHIP (your kids)

Pg 735 lines 16-25 For law enforcement purposes, the Secretary of Health & Human Services will give Attorney General access to ALL data.

PG 740-757 Government sets guidelines for subsidizing the uninsured (That’s your tax dollars peeps)

Pg 757-762 Fed Government will shift burden of payments to Disproportionate Share Hospitals (DSH) to States. (Taxes)
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Page 763 1-8 No DS/EA hospitals will be paid unless they provide services without regard to national origin

Pg 765 Section 1711 Government will require Preventative Services including vaccines. (Choice?)

Pg 768 Section 1713 Government - Nurse Home Visitation Services (Hello union paybacks)

Pg 769 3-5 Nurse Home Visit Services - “increasing birth intervals between pregnancies.” Government Abortions anyone?

Pg 769 11-14 Nurse Home Visit Services include-economic self-sufficiency, employment advancement, school-readiness.

Pg 770 SEC 1714 Federal Government mandates eligibility for State Family Planning Services. Say abortion & State Sovereign.

Pg 789-797 Government will set & mandate drug prices, controlling which drugs will brought to market. Bye innovation

Pgs 797-800 SEC. 1744 PAYMENTS for grad medical education. The government will now control Drs education.

PG 801 Sec 1751 The Government will decide which Health care conditions will be paid. Say RATION!

Pg 810 SEC. 1759. Billing Agents, clearinghouses, etc. required to register. Government takes over private payment system.

Page 820-824 Sec 1801 Government will identify individuals ineligible for subsidies. Will access all personal finances.

Pg 824-829 SEC. 1802. Government Sets up Comparative Effectiveness Research Trust Fund. Another tax black hole.

PG 829-833 Government will impose a fee on ALL private health insurance plans including self insured to pay for Trust Fund!

PG 835 11-13 fees imposed by Government for Trust Fund shall be treated as if they were taxes.

Pg 838-840 Government will design & implement Home Visitation Program for families with young kids & families expecting kids.

PG 844-845 This Home Visitation Program includes Government coming into your house & telling you how to parent!!!

Pg 859 Government will establish a Public Health Fund at a cost of $88,800,000,000. Yes thats Billion.

Pg 865 The Government will MANDATE the establishment of a National Health Service Corps.

PG 865 to 876 The NHS Corps is a program where Drs. perform mandatory HealthCare for 2 years for part loan repayment.

PG 876-892 The Government takes over the education of our Medical students and Drs.

PG 898 The Government will establish a Public Health Workforce Corps. to ensure supply of public health professionals.

PG 898 The Public health workforce corps shall consist of officers of Regular & Reserve Corps of Service.

PG 898 The Public health workforce corps shall consist of civilian employees of the U.S. as Secretary deems.

PG 900 The Public Health Workforce Corps includes veterinarians.

PG 901 The Public Health Workforce Corps WILL include commissioned Regular & Reserve Officers. HealthCare Draft? WTF!

PG 910 The Government will develop, build & run Public Health Training Centers.

PG 913-914 Government starts a HealthCare affirmative action program thru guise of diversity scholarships.


PG 915 SEC. 2251. Government MANDATES Cultural & linguistic competency training for HealthCare professionals

Pg 932 The Government will establish Preventative & Wellness Trust fund - intial cost of $30,800,000,000-Billion.

PG 935 21-22 Government will identify specific goals & objectives for prevention & wellness activities. Control You!!

PG 936 Government will develop “Healthy People & National Public Health Performance Standards” Tell me what to eat?

PG 942 Lines 22-25 More Government? Offices of Surgeon General -Public Health Services, Minority Health, Women’s Health

PG 950- 980 BIG Government core public health infrastructure includes workforce capacity, lab systems; health information systems, etc

PG 993 Government will establish school based health clinics. Your kids wont have a chance.

PG 994 School Based Health Clinic will be integrated into the school environment. Say Government Brainwash!

PG 1001 The Government will establish a National Medical Device Registry. Will you be tracked?

2

PG 1003 9-11 National Medical Dev Reg ‘‘(iii) other postmarket device surveillance activities” you WILL be tracked.
2

PG 1018 States give up some of their State Sovereignty.

Other oddities that have been found worth a mention:
Pages 97-98


[edit on 8/10/09 by redhatty]

reply to post by redhatty


Thanks for posting the Links Red.

So what do you think this bill does most? Reform, setting up a single-payer infrastructure, or just screw things up worse, or not much of anything?

reply to post by Hastobemoretolife


I really don't know. In many ways it seems like the bill takes everyone eligible or borderline eligible for medicaid & puts them on it, then it still offers different "levels" of coverage, just like private insurance.

IF we are going to basically do the same thing we are doing now, what benefit is there from having the .gov running the show?

Has ANYTHING the .gov ever touched ended up running cheaper and more efficiently?

ANYTHING???

Personally I believe that more changes to the cost of health care would be accomplished by strict changes in TORT law and by making it ILLEGAL for a hospital or clinic to run as a "for-profit" enterprise.

But that's just me & for full disclosure, I DO NOT HAVE HEALTH INSURANCE, I self-pay if and when I need medical care.

reply to post by redhatty


I agree, the gov cannot run anything efficiently.

What I see this bill does is set up a single-payer infrastructure, because a lot of this stuff mentioned has nothing to do with reform or setting up an insurance company.

I also agree with making it illegal for insurance and hospitals to work as non-profit and tort reform, I would also like to add that making it to where we can purchase insurance from across state lines would be a huge factor, also make medical cost tax deductible like they use to be.

IMO, this bill is in fact a Trojan horse for a single payer system, nothing in this bill is going to bring down costs, or solve the problems that faces the industry. It actually almost looks like it was set up to cause more problems in long run so they can step in and "fix" it again.

It seems like the most important sections are the vaguest.

I have read through this entire post and I have a few questions. I am hoping the people who did the research can clarify these points.

First hospitals, nursing homes etc are going to be looked at in terms of "quality " of care. Those that do not meet standards are cut from the government program. Is this correct?

Doctors and their families may keep their investments in hospitals and other facilities but they may not INCREASE that investment. In other words doctors can not put another dime into facilities. Is this correct?

Hospitals are not allowed to add operating rooms or patient rooms. The loop hole is community demand. This means either an advertising campaign to gain support or waiting times so long it gets the general population's attention. Is this correct?

Did anyone see anything about how new hospitals are going to be built, old hospitals are going to be repaired or how new state of the art equipment is going to be purchased? Is this going to be done by the government or private enterprise?

I do not see the mechanism that allows new facilities to be built and older facilities to be brought up to date. More importantly I do not see HOW it will be paid for.

Second topic: I see several additional programs added to basic health care. First the perscription change another poster mentioned also:

1. End of life counciling every 5 years. That may not seem like much until you look at this

Today, about 13 percent of Americans are over age 65. By 2030, more than 20 percent of Americans will be in that group. By 2050, about 89 million Americans will be over age 65, more than double the number today. Source

That looks like over 40 million additional consultations in the first year if all those over 65 receive the mandatory talk and 5 to 10 million a year there after. Where are the doctors performing these consultations coming from and who is paying?

2. Home parenting visits. I think this is something brand new. How are these people being trained and where are they coming from?

3. Expanded health care at schools. Who pays for the facilities? Where do the doctors come from?

4. Task force to track and analyze medical devices. This looks like it will be a HUGE on going study. where do the doctors/researchers come from? Who is paying for the trust that funds this.

5. Preventative care studies (and implementation) This looks like another HUGE on going study.

6. Quality of care and whether a treatment actually works. Again both of these are HUGE on going studies. Where do the doctors/researchers come from? Who is paying for the studies.

With all these additions to the cost of "healthcare Insurance" I do not see how the actual costs to the consumer will go down without denying care to the elderly at the very least. I also do not see where new hospitals to replace the old are coming from. No Venture Capitalist is going to front the money and if the government is trying to hold down costs, building new facilities and buying new equipment is going to be very low priority. Also if a treatment is new how do you show the government gate keepers it works without it being implemented so the gate keepers can do their study thing (#5 above)

My biggest question is how this is going to be paid for. The USA just got her credit card yanked, foreigners will not buy any more of the US of A's treasury bonds. US citizens are hurting so they are not buying bonds and with increasing unemployment overall tax revenue is down. If this program wipes out private insurance and this program tanks what happens to the US citizens health care?

An additional tax of 6% for $50,000 a year generates 3000 dollars in additional revenue. That will not buy health insurance. When I was self insured I was paying 500 a month and that was over ten years ago. I just can not see this costing Americans less than 15% to 20% in actual taxes. A tax on your employers payroll is really a tax on you because he will adjust his wages accordingly or go out of business. (Business taxes are the way Congress hides the true cost of a program, with the side effect of driving business overseas.) Again any comments?

Originally posted by crimvelvet
I have read through this entire post and I have a few questions. I am hoping the people who did the research can clarify these points.

First hospitals, nursing homes etc are going to be looked at in terms of "quality " of care. Those that do not meet standards are cut from the government program. Is this correct?

The relevant pages in the bill are (in part) ppg, 525-620. From what I've read it is more about the efficiency of care vs cost of care, not much at all about quality of care. This Post discusses the .gov definition of "Quality" in Health Care

Doctors and their families may keep their investments in hospitals and other facilities but they may not INCREASE that investment. In other words doctors can not put another dime into facilities. Is this correct?

Discussed here and here

Hospitals are not allowed to add operating rooms or patient rooms. The loop hole is community demand. This means either an advertising campaign to gain support or waiting times so long it gets the general population's attention. Is this correct?

Discussed here

Did anyone see anything about how new hospitals are going to be built, old hospitals are going to be repaired or how new state of the art equipment is going to be purchased? Is this going to be done by the government or private enterprise?

Good question!!! I don't recall seeing anything about "new Hospitals" or "new equipment" or "new technologies"

I do not see the mechanism that allows new facilities to be built and older facilities to be brought up to date. More importantly I do not see HOW it will be paid for.

me either

Second topic: I see several additional programs added to basic health care. First the perscription change another poster mentioned also:

1. End of life counciling every 5 years. That may not seem like much until you look at this

Today, about 13 percent of Americans are over age 65. By 2030, more than 20 percent of Americans will be in that group. By 2050, about 89 million Americans will be over age 65, more than double the number today. Source

That looks like over 40 million additional consultations in the first year if all those over 65 receive the mandatory talk and 5 to 10 million a year there after. Where are the doctors performing these consultations coming from and who is paying?

US Taxpayers and Businesses that employ them

2. Home parenting visits. I think this is something brand new. How are these people being trained and where are they coming from?

Well, there are quite a few provisions for scholarships for training doctors. nurses, occupational therapists, techs, etc. in the bill

3. Expanded health care at schools. Who pays for the facilities? Where do the doctors come from?

Again the US taxpayer and the businesses that employ them will be the ones paying, I do not expect to see many doctors at these school clinics, I expect to see more Physician Assistants & Nurse Practitioners.

4. Task force to track and analyze medical devices. This looks like it will be a HUGE on going study. where do the doctors/researchers come from? Who is paying for the trust that funds this.

I doubt that this will be much different than how things are now. The major difference I foresee is the national database of who has what in their body.

Right now, the manufacturers know what unit is being used by a registration of the unit/device ID in a "blind" database, the patient is assigned a number, their name is not used to identify them, only the doctor who placed the device is privy to the name AND number of the patient.

If, say a pacemaker, is in 200 people and 40 of those pacemakers show symptoms of being defective in some way, the manufacturer can tell this trough the blind database and order the recall.

I doubt that this mechanism for monitoring the efficiency of devices will change in any material way, but the US taxpayer will be paying for it twice. Once as we pay for the device to be prescribed and implanted and once when we pay the .gov to monitor the monitoring already happening by manufacturers

5. Preventative care studies (and implementation) This looks like another HUGE on going study.

6. Quality of care and whether a treatment actually works. Again both of these are HUGE on going studies. Where do the doctors/researchers come from? Who is paying for the studies.

again, these types of studies are already in effect, and in many cases, already funded through .gov medical research grants. It will consolidate what is already happening, and being paid for in some way, by the taxpayers.

With all these additions to the cost of "healthcare Insurance" I do not see how the actual costs to the consumer will go down without denying care to the elderly at the very least. I also do not see where new hospitals to replace the old are coming from. No Venture Capitalist is going to front the money and if the government is trying to hold down costs, building new facilities and buying new equipment is going to be very low priority. Also if a treatment is new how do you show the government gate keepers it works without it being implemented so the gate keepers can do their study thing (#5 above)

Oh this is gonna cost, I've seen estimates running from $3,900 per person (including children) to $52,000 per working taxpayer.

As for new treatments, I see little change in the current system to the new system, for drugs, medical devices, etc.

My biggest question is how this is going to be paid for. The USA just got her credit card yanked, foreigners will not buy any more of the US of A's treasury bonds. US citizens are hurting so they are not buying bonds and with increasing unemployment overall tax revenue is down. If this program wipes out private insurance and this program tanks what happens to the US citizens health care?

That's the biggest question, where is the $$ going to come from. Last month ALONE we sold HALF THE DEBT FROM LAST YEAR (2008) and we are going to try and sell one half of that again This Week!!!

When the $$ really does run out for the US, the last thing most people will be focusing their worry on is health care, survival yes, healthcare, not so much.

An additional tax of 6% for $50,000 a year generates 3000 dollars in additional revenue. That will not buy health insurance. When I was self insured I was paying 500 a month and that was over ten years ago. I just can not see this costing Americans less than 15% to 20% in actual taxes. A tax on your employers payroll is really a tax on you because he will adjust his wages accordingly or go out of business. (Business taxes are the way Congress hides the true cost of a program, with the side effect of driving business overseas.) Again any comments?

Many comments, and I've added them along the way. Thank you for your thought provoking questions!!

I love that this is finally getting a finetooth-comb makeover, I just wish it hadn't started with such a sensationalist "twitter" posting by someone clearly with an agenda. Much of that (and how it was posted) is stretched and misinterpreted or just flat-out wrong. Some of it is more on, but it's also blown out of proportion.

Now to catch up on all the interpretations and deciphering of this huge document.

Originally posted by Jenna

Originally posted by exile1981

Actually I take it to mean that if I own company A and I higher company B to do work for me under contract then the amount of my payroll and the amount paid to B will be combined as far as determining my tax rate. I think this is to stop someone from making all of there employees contract employees and thereby reducing "payroll" and tax rate.

You could be right. I've never had to mess with payroll, aside from being on the receiving end of it

, so I don't understand the mechanics of it aside from the basics. I didn't know that payroll could be reduced by calling your employees contractors.

I've only ever had to worry about it while in Canada so my stuff may be a little off but... here is an example I know about people doing. If you have above X employees then you have to submit the payroll withholding tax monthly versus quarterly. During a year the interest saved on not having to borrow money as part of your LOC, if you use the reserved payroll money as part of your operating LOC is quite large. So if you have more than X people you start a wholly owned subsidiary (called Y) and make enough of the employees work for Y that neither X or Y pay monthly. Another example is up here we have WCB which pays workers money if they are hurt on the job. Each company pays an amount into the WCB coffers based on how dangerous the work done there is, it's a % of the payroll. So again if I own a manufacturing plant called X, all of my shop floor workers are working in a high risk job (big machines and all) so I pay a WCB 'fee' of 6% of my payroll. If I'm smart I start company Y and move all of my admin staff and sales staff to work for Y since those jobs are charged 1/2% of payroll as the 'fee'. I used to manage a manufacturing plant that had 10-15 employees and the parent sales company had 12 admin and sales staff that sold what we built (they had over 1 million is payroll) so the difference was about $62,000 per year they saved in WCB 'Fees' each year since the support staffed where charged at the lower rate.

Just my thoughts on why it's worded that way.

Originally posted by crimvelvet
I have read through this entire post and I have a few questions. I am hoping the people who did the research can clarify these points.
2. Home parenting visits. I think this is something brand new. How are these people being trained and where are they coming from?

I live in Alberta and in the rural area we live in they do these home parenting visits. I have no idea how yours will be run but there is a huge difference between the good ones and the bad ones.

The good ones are specially trained nurses who come to your home to weight the baby about 3-7 days after birth (we only get 24 hours of hospital time unless there is a problem). They check to make sure the baby is healthy and gaining weight. They phone first to tel you when they will arrive. This is what we had with the 1st two kids.

The third child we had one of the bad ones. She showed up with out phoning, walked into our house without knocking or ringing the bell. Scared my wife when a stranger wanders into the house (we lock our door now). It was winter and she tried to put the newborn she stripped naked onto a ice cold metal scale from her car trunk. He screamed and wouldn't sit still, he had lost some weight she then accused us of not feeding him and told my wife that if we didn't take him to the hospital ASAP that she would call social service to take all three away. Lets just say there was nothing wrong with him and her boss had her transfered to another part of the health system.

Anyways the idea is it's one less doctors visit the baby needs to make and a nurse is cheaper than a doctor. Plus it's good for parents that are new to get the help in things they may not understand or know about. In the cities they stopped the program as the hospitals are close, they only do it rurally now.

reply to post by crimvelvet

2. Home parenting visits. I think this is something brand new. How are these people being trained and where are they coming from?

From what I got of it, they will be setting up schools and the likes to train nurses and what not for things like this, kind of like extra schooling and added course to get you RN or any of those titles.

I don't necessarily see it as a bad thing, but I don't see how this is going to cut costs, because we will be adding more people to payroll. That last part is my opinion at least.

I found this about the "mandatory" end of life consultation.

The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—
‘‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
‘‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
‘‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—
‘‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;
‘‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;....

So it looks like it is mandatory unless state law does not allow living wills and what not.

reply to post by redhatty


I agree with you red, Much of the cost of medical care is because of insurance for lawsuits. It is also because of all the paperwork created by the government, Medicare, HMO's and the rest. I also have no coverage and go to a Doctor who will have nothing to do with medicare or insurance companies. He is MUCH cheaper because he doesn't have the overhead.

So, I'm not a big ATS'er. I mostly just come here to peruse things for a bit before bed, but I noticed that there hasn't been any mention in this thread of one of the most blatant red flags in the health care bill. I've read through most of the document word for word, and this statement stands out the most:

15 SEC. 155. SEVERABILITY.
16 If any provision of this Act, or any application of such
17 provision to any person or circumstance, is held to be un
18 constitutional, the remainder of the provisions of this Act
19 and the application of the provision to any other person
20 or circumstance shall not be affected.

For reference, this is on page 53. So, mull over this for a moment... I interpret this to mean something like "if someone says they've been put in an unconstitutionally handled situation by this bill, they can appeal... but that provision will not be changed regardless of the fact that it's unconstitutional." Hmm, well, it's cause for worry when -one- Amendment of the constitution is held in disregard... BUT THE ENTIRE CONSTITUTION?! That's, simply put... Irksome.

[edit on 11-8-2009 by farrow]

Off topic but of interest.

What is the DOCTOR"S point of view to all this mess? I googled for "going Galt" and doctors and found a interesting site called When Doctors go Galt. Here are some of the comments from the Doctors as they talk among themselves.

I know one doctor who’s quit taking payment from insurance programs, and quit carrying malpractice insurance. He’s transferred his assets to his wife’s name in an attempt to render himself “judgment proof”. (He has a notice at the front desk warning all comers of this. Those who object are welcome to take their business elsewhere.) But his charges are quite low, since he doesn’t have to split them with a malpractice insurance provider.

Whether this is effective or not … I’m not prepared to say. It hasn’t been tested yet. But in a big way, he’s definitely dropped out of the system.

This agrees with what Redhatty and I were saying above.


These three quotes give a picture of what is wrong with the system and about to become worse.

I accepted Medicaid for about 2 months of my practice. Even thought the reimbursement was substantially lower than my stingiest insurance, I figured it would allow me to treat kids that needed it and at least cover my staff costs. How wrong I was. They denied procedures all the time, delayed billing ( I didn’t get paid for up to 8 months post-op) and were a pain in the ass generally. The support was rude and clueless. Now insurance companies suck too, but Medicaid was like dealing with Nazi nurse Wratched. So I dropped out and now just see poor kids for free. No way in the world I will ever deal with a Government controlled care system again. Ever.

If we want to create shortages of medical services here in the US, single-payer care is the way to go. The red tape of Medicare and Medicaid is already creating such shortages among those patients the system is designed to help.

Hells Bells Captain, that’s pretty much the whole (unstated) point of nationalized health care in the first place. Why are you surprised? The point is to ration health care. One way of doing that is to explicitly refuse to pay for various tests and treatments. But, another is to just make it plain hard for patients to get in to see a doctor. That’s something that the HMOs have done for many years by refusing to allow certain competent physicians on their panels even though those physicians would have been happy to accept the level of reimbursement the HMO was offering.

This is a disaster waiting to happen. Americans are not going to tolerate the kind of system they have in Canada or the UK. Too bad most of them won’t have a choice. I don’t think the Democratic Party has any idea how much damage nationalizing health care is going to do to them.

"My sister is a cancer doctor. We once figured out that Medicaid paid her $7 per hour for the time she spends with a cancer patient...."

I am the head of a Nuclear Medicine department here in East Texas. We recently stopped doing Octreotide studies, a cancer and infection-seeking test we had offered for more than 19 years because our cost for the procedure was about $1500.00 and our reimbursements were south of $700.00. Even with the hospital donating all services, we were losing money on the Indium 111 radioactive dose. After losing tens of thousands of dollars in 2008 on this procedure, I was informed that we no longer offered this service. Now my patients are referred to a facility 60 miles away, a difficult and uncomfortable drive if you are sick and miserable. I don’t blame my hospital; we are laying off and cutting costs just to stay viable in our network. We know who is to blame; Medicare and Medicaid reimbursement.

It’s not just that doctors stop seeing Medicare patients. Sometimes, hospitals stop doing procedures which Medicare will not reimburse them for. I remember when the hospital I worked for stopped doing cataract surgery because we had so many Medicare patients, and the reimbursement didn’t begin to cover the expense. So we stopped doing them. I believe we are doing them again now, but it’s because we now have a smaller percentage of Medicare patients.

Yes I know too many quotes but it does give you an idea of what will happen when/if this bill goes through. Hospitals and doctors can not operate at a loss and will just quit and do something else. I imagine black market medical care will spring up like the black market illegal abortion clinics in the 1950's

Maybe Mexico will get smart and the whole USA medical industry will move south.

reply to post by farrow


They put that provision in every bill that they write. To me it just says, "we don't care about the people of this country, we only care about what power we are allowed to get away with." Same thing with the "hate crimes" bill. If the hate crimes bill is found unconstitutional everybody convicted under it will still serve the punishment that was handed out to them when it was legal.

Gatta pack the corporations pockets that serve the prisons you know. :shk:

@crimevelvet

I agree I do have a feeling that black market medicine will pop up all over the place. I did a thread a while back on why the health care costs are so high, and its due to HMO's PPO's and Medicare and Medicaid.

It's ridiculous all the problems with our health care system have been created by the government, and here they go trying to "fix" what they themselves created.

[edit on 11-8-2009 by Hastobemoretolife]