the doctor is IN

It’s a slow day, and I decided to do a little light reading.  Specifically, I decided to read about health care!  It’s a fascinating subject!  Did you know, for example, that the Republicans would have us believe that our honorable president wants to set up “death panels” that will weed out the weak and infirm?  Being able-bodied myself, I estimate that, barring any unforseen accidents, I will be in support of this policy for at least four more decades!  SOCIAL SECURITY CRISIS?  NOT ANYMORE!

Eager to do my civic duty, I turned to the bill itself: H.R. 3200.  Imagine how disappointed I was when a quick keyword search for “death panels” turned up no results.  Aha, I thought.  Government jargon.  But there wasn’t anything for “Thanatoid Committees,” either, or “Mortality Czar.”  At a loss, I even tried “fascism.”  Nada.  What was going on here?

Gentlefriends, I began to suspect that perhaps the GOP pundits had led me astray.  HOW COULD YOU LIE TO ME, FOX NEWS AT 5?  I TRUSTED YOU.

And so, I set out to find out what this health care reform business is really about.  This was not a task for the faint-hearted (esp. if one is uninsured).  The bill is over 1000 pgs. long, and became abundantly clear that the only way to properly analyze it was one bit at a time.  Today we’ll cover Division A, Title I.

The bill begins by stating its objectives:

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

One of the ways it will do this is by making health care affordable and more available.  Did you know there are MILLIONS of uninsured people in the U.S.?  Did you know that forcing them to wait for treatment until they are desperately ill costs much, much more in tax dollars than paying for routine check-ups?  It’s true!

Why DOES health care cost so much anyway, when hospitals are always complaining about lack of funds, but the patients just keep paying and paying and PAYING.  Who’s syphoning off all that extra money?  Could it be THE INSURANCE COMPANIES?  Don’t you think it’s a bit odd that their profit-maximizing interests (capitalism enthusiasts will remember that firms are ALWAYS profit-maximizing) DIRECTLY contradict those of the people they purport to help?  That indeed, they are always seeking way to deny and/or delay care, all the while raising premiums?  Hey, maybe we should institute some reforms, that would, say, allow everyone who is employed to receive coverage, and prevent insurance companies from doing things like changing the terms or conditions of coverage and raising premiums.  Coincidentally, that’s exactly what the HR 3200 proposes to in Section 102.

HOWEVER, you can reject the government’s genorosity, should you wish to do so!  There is a provision for keeping current coverage, which stipulates that “‘grandfathered health insurance coverage’ [which] means individual health insurance coverage that is offered and in force and effect before the first day of Y1 [2013] if…conditions are met…” can be kept in addition to or instead of the newer, employment-based plan.

Subtitle B gives a more in-depth look to insurance reforms: insurance companies will no longer be able to “impose any pre-existing condition exclusion…based on any health status-related factors.”  So even if you are old and sick (or a baby w/ a developmental disorder that could require costly surgeries), they STILL have to insure you.  Then, they have to agree to renew your plan!

The bill seeks to provide everyone w/ what it calls “minimum services”:

  1. Hospitalization
  2. Outpatient hospital and outpatient clinic services, including emergency department services.
  3. Professional services of physicians and other health professionals. (Editor’s note: Comments can be forwarded to the Office of Redundancy Office!)
  4. Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
  5. Prescription drugs.
  6. Rehabilitative and habilitative services.
  7. Mental health and substance use disorder services.
  8. Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
  9. Maternity care.
  10. Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

Moreoever, there WILL BE NO COST-SHARING.  Not even for the childcare.  That’s right, these “minimum services” will be provided free of charge (up to $5000 for individuals and $10,000 for families).

An advisory board will be instituted to oversee all this, and to submit recommendations to the Health Secretary.  Note: these committee members will receive per diem travel expenses, but no additional pay (which seems altruistic, but may just make them vulnerable to evil insurance lobbies in the future, I don’t know).  The rest of the section deals w/ how the Secretary will implement the committee’s findings.  Blah blah blah no death panels.

Subtitle D lays out more consumer protections.  For instance, the appeals process on claims must now be overseen by a third (objective!) party!  No more rejecting Mrs. Madison for hip surgery b/c she was born on a Tuesday evening when Saturn was aligned w/ Mars, but had FAILED to apprise the insurance company of this added risk.  The Health Commissioner will also demand “the accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information as determined appropriate by the Commissioner. The Commissioner shall require that such disclosure be provided in plain language.

Subtitle E discusses the Health Commissioner, what his/her exact role will be (establishing health benefits and overseeing the Health Insurance Exchange by conducting audits and–if necessary–imposing sanctions), who he/she will consult w/ (The National Association of Insurance Commissioners, State attorneys general, and State insurance regulators, among others), and how all those efforts will be coordinated.  The Commissioner will also select some poor schmuck to deal w/ everyone’s bitching and moaning.  This is known in government jargon as an “ombudsman,” an ancient word that is a contracted form of “OW, you’re busting my balls, man.”

And that, my friends, is all I have energy for today.  There are two more subtitles in Division A remaining.  Luckily, Title II is considerably shorter.

You may be wondering, how are we going to pay for all of this?  Here’s an idea from HR 3200:

Sec. 441. Surcharge on high income individuals.

Huh.  You know, I think I just found the REAL reason that all the prominent Republicans are up in arms over health care reform.


2 thoughts on “the doctor is IN

  1. I’m sure you’ll let us know when you get to the parts where our freedoms get hijacked.

    Happy reading!:-)

  2. Your writing always impresses me; keep up the good work. Bringing facts to light, even when the truth is ugly–I was pretty bummed out that there were no death panels too.

    I think Canada has some good ideas with health-care: they emphasize exercise to prevent some of the most common ailments, like high blood pressure or heart disease. Maybe Obama could get the message out that exercise is cool through the Twitter? Let’s see who argues with him there–who’s the lobby that wants to keep Americans fat? Not to mention, a genuine twitter debate would be absolutely hilarious.

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