WhiteCoat

Highlights from the Health Reform Bill

These highlights were sent to me in an e-mail.

I have not read the entire bill. However, I did check some of the highlights against the text of America’s Affordable Health Choices Act of 2009 (H.R. 3200) and they are generally on point, although some of the commentary isn’t entirely accurate.

As one example, the Advance Care Planning Consultation in Section 1233 does not permit the government to “order” your end of life care, but only requires that a physician discuss the matter with a patient and denote the patient’s preferences (Section 1233(a)(hhh)(5)(A)(ii).

However, the government does plan to establish a “quality reporting initiative” for end of life care that will essentially coerce physicians into doing what the government wants under the threat of being deemed a “low quality provider” if the physician does not comply. If the government states that “quality care” for end of life involves removing life support on patients that show no improvement after 72 hours, any physician that keeps comatose patients on life support longer than 72 hours will get quality “demerits” from the government. The government may then use those demerits to dock the physician’s pay or to post the physician’s name as providing “low quality” end of life care on some web site. Think about a tremendous database of physicians similar to the “HospitalCompare.gov” web site now. Because of Hospital Compare, hospital administrators strive to be at 100% “quality” even though “good” care may sometimes cause excessive costs without benefit, may be more likely to misdiagnoses and wrong treatments (I commented on this issue previously and the link to the actual article on a government website mysteriously went bad), or may even be more likely to contribute to patient deaths.

Draw your own conclusions after reading the sections in the bill. Commentary (from unknown source) is contained below.

————–

• Page 22: Mandates audits of all employers that self-insure! (Section 142(b))
• Page 29: Admission: your health care will be rationed!
• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
• Page 42: The “Health Choices Commissioner” will decide health benefits for you. You will have no choice. None.
• Page 50: All non-US citizens, legal or not, will be provided with free health care services.
• Page 58: Every person will be issued a National ID Healthcard. (Section 163(a) – not entirely accurate – potential action, not mandatory)
• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer. (Section 163(a) – not entirely accurate – potential solution, not mandatory)
• Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
• Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)
• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
• Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter. (Section 205(b)(3))
• Page 124: No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly. Put simply, private insurers will be crushed. (Section 223(f))
• Page 127: The AMA sold doctors out: the government will set wages. (Section 224)
• Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
• Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.
• Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll (Section 412(c))
• Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll
• Page 167: Any individual who doesn’t have acceptable healthcare (according to the government) will be taxed 2.5% of income.
• Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them) (Section 401(a)).
• Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
• Page 203: “The tax imposed under this section shall not be treated as tax.” Yes, it really says that. (Section 441(a))
• Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected. (Section 1121(c))
• Page 241: Doctors: no matter what specialty you have, you’ll all be paid the same (thanks, AMA!)
• Page 253: Government sets value of doctors’ time, their professional judgment, etc.
• Page 265: Government mandates and controls productivity for private healthcare industries.
• Page 268: Government regulates rental and purchase of power-driven wheelchairs.
• Page 272: Cancer patients: welcome to the wonderful world of rationing! (Section 1145)
• Page 280: Hospitals will be penalized for what the government deems preventable re-admissions. (Section 1151(a))
• Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
• Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
• Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
• Page 321: Hospital expansion hinges on “community” input: in other words, yet another payoff for ACORN.
• Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
• Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
• Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals. (Section 1177)
• Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
• Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia? (Section 1233)
• Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.
• Page 425: Government provides approved list of end-of-life resources, guiding you in death.
• Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
• Page 429: Advance Care Planning Consult will be used to dictate treatment as patient’s health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT.
• Page 430: Government will decide what level of treatments you may have at end-of-life. (Section 1233(b))
• Page 469: Community-based Home Medical Services: more payoffs for ACORN.
• Page 472: Payments to Community-based organizations: more payoffs for ACORN.
• Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage. (Section 1308(a))
• Page 494: Government will cover mental health services: defining, creating and rationing those services.

42 Responses to “Highlights from the Health Reform Bill”

  1. I voted for Obama. I wanted a mass extinction of left lane, slow driving old people. Now I get my wish. I wanted cheap illegal alien workers for my vast estate. Got it. I wanted to unload my employee health needs on the taxpayer. Got that. This is great news.

  2. paul says:

    i’m sorry, but this sounds like right wing hysterics to me. the overemphasis on treatment of illegals and more importantly the fact that i saw this first on MDOD are pretty clear indicators of that. why don’t you now post the fluffy liberal interpretation of the bill which will portray it as wonderful and flawless? then (having not actually read the bill myself) i’ll assume the actual bill will fall somewhere in between.

    i mean, all doctors’ salaries the same regardless of specialty? and determined by the government? you’d have doctors leaving the country or clinical practice in droves.

    • Fyrdoc says:

      “you’d have doctors leaving the country or clinical practice in droves.”

      To do what and go where? Most of us have extensive debt (obtained to earn that MD degree) and are established with friends and family in the community. What marketable skills outside of medicine do we have? No, the problem will not be now. The problem will be in ten years. Who exactly is going to sign on to medical school, assume huge debt to obtain their education, onl to make government controlled (read constantly shinking) wages?

      • paul says:

        i think my point was not that doctors are actually all going to quit, but that this analysis of the bill is bogus.

        simce some of you clearly needed that clarification.

      • Matt says:

        Agreed. It’s a bogus argument whenever it’s raised.

    • Matt says:

      Thank you, Fry, for pointing out the obvious logical problem with the “disappearing doctors” claims we’ve been hearing for a decade now.

      • Fyrdoc says:

        Matt,

        Don’t discount the very real problem of shrinking applications to medical school and easing of admissions requirements as a result. And all of this coming with mandating easing of work hours on residents without lengthening terms of training. Even you can see the problem with medical schools having a constantly increasing amount of necessary information to impart on a less qualified student body followed by a residency where the amount of patient contact hours have effectively (in some cases) been halved. As an educator, I can tell you that I am not as well trained as the physician who completed training five years ahead of me. And this year’s graduates are NOWHERE near as well trained as I was. This trend will not end soon.

        IF you accept that healthcare reform is needed, then medical education must be reformed too. Move to a European or Canadian system. Entrance purely by pre-qualification (i.e., completion of necessary coursework) and examination. Government finances the cost (i.e., it is free), and residencies are longer, but much better compensated (e.g., emergency medicine training in Canada is 5 as opposed to the U.S.’s 3 years, but ther resdents are much better paid)

      • Adam says:

        FryDoc said:

        “Don’t discount the very real problem of shrinking applications to medical school and easing of admissions requirements as a result.”

        This is most easily verifiable piece of BS I’ve ever seen on the internet. Either the AAMC or you are full of it.

        GPA/MCAT has gone up every year since 1997, and number of applicants has gone up every year since 2002.

        http://www.aamc.org/data/facts/2008/2008mcatgpa.htm

        Could you post where you got your info, I’d like to see it.

      • Fyrdoc says:

        Well, the data are here: http://www.aamc.org/data/facts/2008/2008summary2.htm as to the shrinking applicant pool. I only have a print copy of the databook (the full AAMC data set) but the GPA and MCAT scores you cite are somewhat falsely elevated when you adjust for only undergraduate GPA to first degree (not later work) and first attempt at MCAT.

        As a recent admissions committee member, the overall quality has applicants has continued to diminish over time. Do you suspect that trend will reverse under the new federal guidelines? And the reduction in hours of residency is well known – how many residencies have increased their length to compensate? How many medical schools have moved to 5 or even 6 year courses of study to compensate for the vast increase in medical knowledge present since the Flexner report suggested a 4 year program?

      • Adam says:

        From FryDoc: “Well, the data are here: http://www.aamc.org/data/facts/2008/2008summary2.htm as to the shrinking applicant pool.”

        .2% drop on overall applicants in the past year. Interesting. This years data will be interesting – what will a poopy economy do to applicants? Overall, the graph is a major upward trend – unlike my portfolio. Up every year since 2002 and a .2% dip last year.

        Also, you said “somewhat falsely elevated when you adjust for only undergraduate GPA to first degree (not later work)”

        Not sure what you mean here. Should later work not be included in the GPA? I had a 35+ year old coworkers with an old crappy GPAs go back and get 60 credits of 4.0 on bio/chem type classes. Is this inflating the overall GPA?

        around %55 of folks don’t get in based on these numbers. most folks would have a hard time buying the argument that people aren’t going into it.

        5 or 6 years of 80-100 hour school weeks, followed by even longer, lowly paying residencies? that would be a good way to lower the applicant pool. instead of $160,000 in debt, they could be $240,000, and the interest could grow another few years while they are getting pounded in the arse while doing longer residencies.

        with those numbers maybe people couldn’t get loans for it all – and only kids with rich parents could be docs. scary.

      • Fyrdoc says:

        Adam,

        Yes, there is inflation by re-applicants. Read those numbers. Also take into account the number of available seats. There is no question the strength of the overall applicant pool is declining.

        And as I said in my original post, none of the needed reforms can happen unless we switch to a European or Canadian system where medical school is free and residents far better compensated.

  3. Chris says:

    So I’m not a fan of this bill, but some of this is just incorrect or at least distorted.

    “• Page 241: Doctors: no matter what specialty you have, you’ll all be paid the same (thanks, AMA!)”

    If I’m reading this correctly, they’re referring to the part that says
    “6 Service categories established under this paragraph
    7 shall apply without regard to the specialty of the
    8 physician furnishing the service.’’.”

    Which basically means that a surgeon placing a central line will get paid the same amount as an EM physician placing a central line. Which makes sense.

  4. rsm says:

    I wanted cheap illegal alien workers for my vast estate.

    Sorry, not getting that. At least not in Jersey and on Long Island…

    i’ll assume the actual bill will fall somewhere in between.

    Optimist. The problem isn’t the bill per se. The country can use a health reform as there are problems with the existing system. The problem is that no one involved in the process is actually interested in thinking about the issue, considering consequences or trying to put out a decent product. What they want is an ad hoc piece of ‘emergency’ crap that they can amend to suit their needs, contingencies and ideological framework.

    As usual people are trying to discuss substance, when there is no real substance and speed is the issue – No one should try to pass health reform over one term, or ‘before the senate break’ that’s stupid beyond belief, if you assume that the people pushing this are incompetent. If on the other hand you assume competency and intelligence it is at best a fraud and at worst evil.

  5. shadowfax says:

    BOOOOGUUUUS!

    Seriously, from line one to the end there is almost zero validity to this BS.

    Take the FIRST example:
    “Page 22: Mandates audits of all employers that self-insure! (Section 142(b))”

    In fact Sec 142(b)(2)(A) requires “random compliance audits and targeted audits in response to complaints.” Not audits of “all employers.”

    Minor distinction, don’tyouthink?

    And this:
    “Page 50: All non-US citizens, legal or not, will be provided with free health care services.”

    Is as far as I can tell, made up out of whole cloth. No citation is given (because it ain’t in the bill) and pg 50 in the actual bill text released by the House has to do with some boilerplate construction issues.

    Seriously, WhiteCoat, you put this sort of stuff up with a vague endorsement, but it’s a load of BS. Either you’re trying to participate in the disinformation campaign or you get fooled, but this is beneath you.

  6. Fyrdoc says:

    WC,

    A lot of this is fear mongering. If you actually look at the law, it doesn’t say most of what your post suggests.

    For example – the “National ID Card” states that a machine readable card may be used to determine if a person is eligible under a certain plan. How is that different than the machine readable card I have in my pocket right now from BC/BS?

    The payment for all specialties will be the same – true, but this is payment for a specific service (CPT code) will be the same regardless of specialty. All this says is that we get paid the same as a surgeon would for putting in the same central line. It allows primary care physicians to perform procedures and bill at the same rate as a specialist for the same procedure. It will NOT suddenly provide privileges for an FP to do CABGs (but if they did, they would be paid what a CT surgeon is).

    Keep in mind, this is no where close to what a law will look like, there will be a Senate version, then and reconciliation mark-up, then a law.

  7. BK says:

    WC,

    You’ve had some shoddy arguments in the past, but this one takes the cake…by far!

    Commentary (from unknown source) is contained below.
    This doesn’t worry you at all? In a debate so filled with misinformation, halftruths, and outright lies, you’re posting some unknown partisan hacks interpretation of the bill? (and yes, if you look down the list it is obviously made by a partisan hack).

    I wish I could say I was surprised that you posted this.

  8. kidsdoc says:

    What really disappoints me about this is that–once again–the Repubs make up lies and use the confusion inevitable in congressional documents to scare the public instead of informing us. How many Americans will actually read the entire document to see what is true? How many will understand the language? This just makes me think that they have no other rational arguments against this legislation and are opposing it either out of greed or fear of change.

  9. marie says:

    We already have a glimpse at how such a thing will be run in the US – take a look at organ shortages, where the cost of an organ can never be greater than zero. And we all know how easy it is to get a liver.

  10. wkct says:

    everyone wanted change – here it is!

  11. Rebecca says:

    “Government will cover mental health services: defining, creating and rationing those services.”

    I wish.

  12. I tried to link to the Act. Got this.

    GovTrack.us Is Temporarily Unavailable

    NOTE: Once Congress goes on break in mid-August we’ll be upgrading our hardware so we have less downtime once the fall session begins. 7/30/09

    GovTrack.us is currently having some down time. Either the website is undergoing maintenance, or the site was shut down because of an error or high load.

    Please try reloading the page in just a few moments.

    If the problem persists, please bookmark this page and return in a few hours. Thanks for visiting!

  13. Doc99 says:

    You can find a pdf of HR 3200 Here.

  14. RosenKris says:

    A complete, point by point rebuttal of this “chain email” (their words) on health reform can be found at

    http://www.politifact.com/truth-o-meter/article/2009/jul/30/e-mail-analysis-health-bill-needs-check-/

    I found the link on the Association of Health Care Journalists site.

    Whitecoat, will you also be posting the Nordstrom’s cookie recipe so we don’t get charged $250 when we ask for it. :)

  15. Mass says:

    (Reposted here from older post)

    I have been reading this blog now, originally attracted by the White Coat Lawsuit series, but then have gotten sucked into paying attention to the roiling waters over the Health Care Reform debate. In no particular order, here are a few thoughts:

    1) I’d like to know how Dr Whitecoat is an “Independent Voice for Emergency Physicians”? Does that mean that all or most independent ER docs are conservatives or Republicans or anti-HR 3200? It would seem so as there are plenty of references in his blog to the loaded phrase “socialized medicine” as well as (at times indirect) links to groups like CAHI (the health insurance lobby) or the NCPPR (a conservative lobby) or to other conservative blogs. Either admit you’re a proud conservative or give some left-leaning blogs and groups some links.

    2) How would WC doc define “socialized medicine”? Are patients in the VA system, or those who have Medicare or Medicaid part of such a system? Does it matter that Medicare patients have higher satisfaction than other insured patients? I would submit that if WhiteCoat Doc would term universal healthcare as “socialized medicine,” then I can call the present system, “Darwinian every-man-for-himself medicine.” Unwieldy, but accurate.

    3) Is this blog written from the perspective of a professional concerned about his income, independence, status, the overall health of his patients, or some mix of these? While I too am a physician, I don’t believe that physicians’ and patients’ interests always go hand-in-hand. There is no shame in defending our incomes and status – let’s just not delude ourselves that our positions are always for the good of the patients.

    4) If some believe that it is not our health care system’s fault — but other factors like income disparities, personal habits, etc — that we have much higher per capita healthcare costs but worse infant mortality and lower life expectancy than other countries, isn’t it incumbent on us as advocates for our patients’ health to see money directed AWAY from the medical system into areas of the economy that actually WILL improve those health statistics?

    5) Which Republican health care bill currently being proposed ought we to support as an alternative to the current “Obamacare” legislation?

    6) Given that the US spent 8.8% of GDP in 1980, up to 13.9% of GDP in 2001, and then most recently 16% of GDP for health care in 2007,
    (http://www.kff.org/insurance/snapshot/chcm010307oth.cfm) — does anyone think this is sustainable and if not, what are our options? If “rationing” is out and no one (doctors, hospitals, health insurance) wants to get paid less and no one wants any restrictions of any kind on costs, should we all fly to other countries for health care?

    7) Since physicians seem strangely wedded to the idea of the private health insurance industry being the intermediary in our medical system, does it bother anyone that most areas of the US now have near-monopolies by private insurance companies in the markets for medical insurance?
    (http://www.marketwatch.com/story/study-confirms-health-monopoly-fears)

    How does one reconcile the facts that “socialized medicine” in places like France, Germany and the UK are associated with frighteningly “high taxes” (used in menacing ways in posts) but that we spend at least 50% per capita more on health care than any other country? Is it possible that higher taxes are offset by…. something else lower?

    9) When the following post recommended by WhiteCoat doc (http://www.fundmasteryblog.com/2009/07/16/reform-healthcare-culture-and-politics-first/) explains how the free market indeed does work for the medical system, are there, um, more practical examples available than Lasik (a cash-on-the-barrel and completely elective procedure) and traveling abroad for health care? Does any ER doc discuss with a patient the pros and cons of all proposed tests (CMP vs BMP vs cardiac panel vs cardiac enzymes, etc) and radiological studies (MRI vs CT vs ultrasound) including full disclosure of the costs of these tests?

    Sorry for the long post, I look forward to your thoughts. I may think of things later to say. Cheers

  16. Nick Dupree says:

    • Page 268: Government regulates rental and purchase of power-driven wheelchairs.

    Medicare and Medicaid have done that FOR FOUR DECADES. Nothing new on page 268, so this is misleading.

    • Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals. (Section 1177)

    There’s nothing in the bill about restricting special needs individuals. I checked the actual text because I was worried.

    All there is in Section 1177 is a bit about supervising the private special needs insurance plans that are offered under Medicare, which, by the way, THEY’VE ALWAYS DONE!!!

    Someone needs to apologize for the brazen dishonesty of this post, especially the completely fictitious assertions about government deciding end of life care.

    Nick

  17. Doc99 says:

    Indian Health Service – Fail
    VA – Fail
    Federal Prison Health Service – Fail
    Medicare – impending bankruptcy – Fail
    Medicaid – Fail

    • Rebecca says:

      Other countries with socialized healthcare: win

    • Mass says:

      Such a convincing argument you make!

      Re:
      Doc99 says:
      August 4, 2009 at 1:19 pm
      Indian Health Service – Fail
      VA – Fail
      Federal Prison Health Service – Fail
      Medicare – impending bankruptcy – Fail
      Medicaid – Fail

  18. I hope you did not plan on gaining credibility points with this post, WhiteCoat.

    I think I’ll publish equally assinine material “sent to me in an email.”

    Jeezus.

    • Read parts of HR 3200. It is far worse than implied here. Much of it is incomprehensible, vague, and awaits the life and death decisions of future political hacks and lawyers running decision making boards. This is like a mob takeover of a business. It should be physically resisted. If a loved one is denied care, and dies needlessly, knee cap a member of the lawyer and Democrat hierarchy. Let them have chronic pain. See how they enjoy cheap Commie Care.

      • Before I say the part about not wanting you to sully my comment with yours, may I suggest that you consider the most likely cause that something might seem incomprehensible to you.

        Take a gander at comment #20 and see if you don’t perchance employ an excess of Weasel Words…

        Now… don’t piggyback a nonsensical (and uncomprehending) “reply” onto my comments. Thanks!

  19. Pink says:

    Uh-oh, Whitecoat, Big Brother is watching.

    “There is a lot of disinformation about health insurance reform out there, spanning from control of personal finances to end of life care. These rumors often travel just below the surface via chain emails or through casual conversation. Since we can’t keep track of all of them here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov.”

    http://www.whitehouse.gov/blog/Facts-Are-Stubborn-Things/

  20. Emma says:

    I used to enjoy this blog until you reposted this. Very few of these claims have any basis in reality. I am ashamed that more fact checking was not done.

  21. Mass says:

    Kudos to Rosenkris to being one of the few posters to inject some rationality into this debate. I recommend the following weblink to all interested in facts:

    http://www.politifact.com/truth-o-meter/article/2009/jul/30/e-mail-analysis-health-bill-needs-check-/

    I find it curious how often conservatives use loaded words and phrases (Obamacare, socialized medicine, Big Brother, Commie Care, euthanasia, etc, etc) in this health care debate. I have yet to receive any responses to the 9 points I raised last week.

    To those who feel I am impugning the entire political Right, I ask when was the last time that conservatives appealed to a motive other than fear? Fear of terrorists, fear of government bureaucrats, fear of tax hikes, fear of foreigners, fear of just about anything new? Perhaps they are most afraid of facts (or is that an allergy?). That is why lobbying groups are the most opposed to the proposed changes in the government bill. So if you’re a doctor who is worried that you will make less money under this plan, say so. Don’t trot out the lame excuse that you think patients will get worse care.

    Until the Right starts offering actual policies (and facts) rather than retreading the very tired and hackneyed scare tactics more appropriate to Joe McCarthy’s era, they will remain marginalized. Ask the British Tories…

  22. [...] conduct audits of whether qualified health benefits plans are complying with federal requirements. Unlike Shadowfax’s assertion, the wording does not “require[] ‘random compliance audits and targeted audits in [...]

  23. Just American says:

    It’s amazing…if I knew there were so many people out there that knew what was going to happen before it happened, or what a BILL for example is going to look like before it gets chopped up and changed half a million times I would’ve asked someone for some good lottery numbers a long time ago. Honestly this is a scary debate and nobody fully knows what’s going to happen yet or what the pros and cons are just yet. Guarentee anything the government passed, even if your oh so precious Republicans were still in office, that you’d still have a problem with it and it wouldn’t be the most awesome thing ever…this health care reform so far is iffy but does anyone remember what the other side wanted if they got in? You want to talk about scaring…I guess I’m just hopeful and happy that didn’t get in.

  24. DensityDuck says:

    To posters who say “it’s RANDOM audits, not PERPECTUAL audits”…I say “do you know what the term ‘chilling effect’ means?”

    That said:

    “• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)”

    This is FLAT DAMN WRONG. Page 84 says nothing of the kind.

  25. [...] Highlights from the health reform bill (read the comments, that’s where it gets interesting) [...]

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