So Bill can have a Seizure: Healthcare Bill Summary

[IJ]

http://www.washingtonpost.com/wp-srv/sp ... ciliation/

"Makes insurance available to an estimated 94 percent of non-elderly citizens by dramatically expanding Medicaid and offering tax credits to Americans who would otherwise find it difficult to afford coverage."

For a longer read: pdf of whole bill

http://click.jwatch.org/cts/click?q=227 ... ex3xnvA%3D

[Bill Glasheen]

I've been following the selling of poop in a bag for about a year now, Ian. Just when we think the thing is dead and the socialists have finally listened to public opinion, it's baaa-aaack.

Even if it passes, it's not over. Virginia has already passed legislation basically saying we aren't going to play. The lawyers are ready for Constitutional challenges. If it passes, it's going to be ugly. If it doesn't pass, it's going to be ugly. These Chicago politicians asked for a fight, and by golly they're going to get the fight of their lives.

Why these pinheads insist on obsessing over this boondoggle instead of (ahem) focusing on jobs is beyond me. But then in the end it won't matter. It won't fly, and it will be the start of the political pendulum heading in the other direction. Too bad for the Democrats. At least Clinton learned something after his first political whuppin behind the shed. That led to some of his greatest work as a president (before Monicagate). These arrogant folks just don't get it.

- Bill

[Glenn]

finally listened to public opinion

The problem is there is public opinion polls to support both sides, with both sides claiming a "significant majority" supporting their positions...and I don't trust either of them. In general most people seem to think some sort of reform is needed, but the only other things they can agree on is that they don't like the way both sides have conducted themselves in the debate nor do they want higher taxes to pay for any changes. This will, at best, be one of those "you can please some of the people some of the time..." situations.

On the flip side, politicians have an out with the concept that being a leader means sometimes going against public opinion...although that tends to only work until the next elections.

Why these pinheads insist on obsessing over this boondoggle instead of ( ahem ) focusing on jobs is beyond me

Agreed, this health care reform affair has become a major distraction at a time when there are more pressing matters. I suspect that they didn't think it would turn into the time-consuming debacle it did, but really, they should have known better!

[Jason Rees]

I don't suppose there's a section dealing with a time limit and a plug-puller if it doesn't work out as planned? Riiiight. I know, I'm too optimistic.

[IJ]

"Virginia has already passed legislation basically saying we aren't going to play. The lawyers are ready for Constitutional challenges." --Bill

http://content.nejm.org/cgi/content/full/362/10/869

"Whereas states generally adopt laws to achieve a legal effect, nullification laws are pure political theater. On its face, the Virginia bill exempts residents of the Commonwealth from having to comply with a law requiring the purchase of health insurance. Although the bill is phrased in the passive voice, its intent is clearly to block the implementation of a federal mandate requiring all individuals to carry health insurance. But achieving this aim is constitutionally impossible.

The Supremacy Clause of the United States Constitution (article VI, clause 2) states, "This Constitution, and the Laws of the United States . . . shall be the supreme Law of the Land; . . . any Thing in the Constitution or Laws of any State to the Contrary notwithstanding." Indeed, one of the primary reasons for adopting our Constitution in place of the Articles of Confederation was to establish the supremacy of national over state law. Our only civil war was fought over the question of whether national or state law was ultimately supreme. (...)

State law cannot nullify federal law. This principle is simply beyond debate, and state legislators, many of them lawyers, know that."

[f.Channell]

They could try to leave the Union, but that didn't work out so well last time.....

[Glenn]

If Virginia were to succeed again it would take a large chunk of federal employees with it, given how many of them reside in Northern Virginia. Why, this could be a plot to try to bring government to a standstill... if only they could figure out how to get it going again first so that they could then bring it to a standstill!

[Bill Glasheen]

On its face, the Virginia bill exempts residents of the Commonwealth from having to comply with a law requiring the purchase of health insurance. Although the bill is phrased in the passive voice, its intent is clearly to block the implementation of a federal mandate requiring all individuals to carry health insurance. But achieving this aim is constitutionally impossible.

You got a law degree as well, Ian?

The legal challenges were being organized before the bill was passed. Here's the short story on it.

• They aren't likely to get a stay on the execution of this law. So practically speaking, the legal challenge will stretch out over several years. Individuals will have to start ponying up on the new taxes before all is settled.
• As I understand it, Florida is likely to lead the challenge, with 9 or so states jumping in on the legal action. The main issue is whether or not you can constitutionally force an individual to have health insurance. You can do that with auto insurance because having an auto is a choice. But health insurance? There they tread on shaky legal grounds. This will make it all the way to the Supreme Court.
• In order to sucker a half dozen or so pro-life Democrats into voting for the bill, the president signed an executive order saying no federal money would be used for abortions with the new health care legislation. Guess what? That's unconstitutional. Expect a legal challenge, which will lead to the bait-and-switch that was intended all along. And perhaps these "pro life" Democrats knew all along that this wouldn't fly, but they're playing dumb like a fox. They'll tell their constituents that they had no idea this thing would turn out the way it did, and blah blah blah, and oh well can't do nuthin about it now. You get the picture.
• In order to keep the bill under a trillion, they cut Medicare payments to MDs by 21 percent. Not only that, but they DOUBLE COUNTED these savings. Guess what? That ain't gonna fly. Most MDs can't cover their expenses with a 21 percent cut in their CMS reimbursement rate. So this will get changed, which - you guessed it - was a conscious bait-and-switch tactic.
• For the first couple of years, the federal government will cover some of the Medicaid coverage of people who today don't have insurance. But guess what? This gets thrown back to the states over time. Ask me how well that's going to go over in the "red" states. Once again, a conscious bait-and-switch tactic.
• Here's the best part. They have 10 years of revenue collection covering 6 years of return. This was the way to cook the books so that the CBO was forced to report a "savings." God I wish I could do my taxes like that...
• Once 30 million people get thrown into the health care system, primary care in this country will officially be broken. And there's no way that medical schools will be able to train enough PCPs to make up the difference. And besides... who wants to be a PCP these days when you could buy a house with your med school bills and yet you barely make more money than a good plumber. This isn't going to be pretty.
  
  Methinks we're going to end up with NPs and PAs getting battlefield promotions as primary care healthcare practitioners with enough status to bill CMS directly for their services. And commercial insurance will follow. And health care in this country will officially have lost a layer of quality on the most important front.

So that's the skinny.

This thing is far from over.

- Bill

[IJ]

No law degree here Bill, just cut and paste from the NEJM article by a JD. You read that, right?

Speaking of law degrees, why is it unconstitutional for the President to order that no monies go toward abortion? Does this matter, considering also the total theater effect of the abortion fight anyway, what with all such bills in semi-recent history containing Hyde amendment language prohibiting the same, already? Those Democrats aren't playing dumb like a fox; the use of the funds for abortion is prohibited.

Agreed with the bait and switch on CMS payments. It IS absolutely moronic that every year they fake lower then rescind the pay cuts on medicare/medicaid. They need to ration the funds correctly: by prohibiting use of the money for stuff that doesn't work. Period. All of the whiners who want to moan about that being rationing are welcome to go get real private insurance. Funds are not unlimited, and such whiners and moaners need to STFU about rationing already. Let's do it.

Methinks you're right that we'll see a lot of NP and PA's doing more primary care; a lot of the issues faced in primary care do not require an MD's level of training. I do not see, however, that those PCPs are just going to relinquish their status over the nurses and aides. I expect them with AMA backing to maintain supervision status or to confine their extenders to niche practice like diabetes and hypertension or colds and other minor acute complaints. It's worth pointing out that the "most important front" of primary care, as you put it, may not require MD training either. YOU can advise almost everyone about their diet and activity (maybe we get you a day's training on management of exercise with heart disease and lung disease). There is no reason to pay MD's to do that, or to give vaccines, or to perhaps follow a prevention checklist with referral on to doctors as needed. That is simply common sense, much like we don't pay airplane pilots to fill up the gas tank, much like we don't have Stephen Hawking teaching intro physics, and so on. As for your quality concern, NPs can provide excellent care. I think the Annals of IM reported they provided better AIDS care than primary doctors and were on par with ID specialists, in one example; it's not your degree, it's what you do every day.

It's definitely far from over... this is going to be a cost debacle for years. This is the democrats' Iraq war. I see a mess and things emerging somewhat better in a while. Maybe we'll have a "surge" of Primary care, and maybe we'll help the locals do it better by promoting local solutions and maybe we'll face facts and follow my recommendations for enforcing quality improvement and rationing standards. Or we're seriously on the rocks as a nation, our debt will get downgraded, and we're going to be conquered by Mexico in 25 years, who knows. China wins, though... I'm betting on China.

[Bill Glasheen]

No law degree here Bill, just cut and paste from the NEJM article by a JD. You read that, right?

I read it. Now your read what I wrote, no?

Speaking of law degrees, why is it unconstitutional for the President to order that no monies go toward abortion? Does this matter, considering also the total theater effect of the abortion fight anyway, what with all such bills in semi-recent history containing Hyde amendment language prohibiting the same, already? Those Democrats aren't playing dumb like a fox; the use of the funds for abortion is prohibited.

First - The executive branch cannot write law. Period.

Declare war? Sure. Get funding for the war? Not so much.

Here's the thing, Ian. You're going to subsidize insurance for a good portion of the population that can't afford it, right? That's using federal money for a health benefit that - you guessed it - pays for abortion. So voila - you have a federal subsidy for abortion. Pretty cool, eh? (Not)

Now I'm all for a woman's right to choose. I'm all about choice. However I don't want to have to subsidize YOUR choices. That's only fair, particularly since a good portion of the population believes that abortion is morally reprehensible.

I think anti-abortion activists have no right to tell a woman what to do with her body. I'm just as repulsed as the next person when I see the Catholic Church getting their little parochial school kiddies picketing in front of abortion clinics.

But..... I think a woman has no right to ask the public to fund her abortion - in whole or in part. I'll fund an aspirin for her to hold in-between her knees. But I won't fund her oopsies if she chooses to let that aspirin drop. That's a matter for her and loverboy to deal with on their own. If they choose to bring a life into the world, well... SOME things can be paid for from general funds to protect the innocent.

Agreed with the bait and switch on CMS payments. It IS absolutely moronic that every year they fake lower then rescind the pay cuts on medicare/medicaid. They need to ration the funds correctly: by prohibiting use of the money for stuff that doesn't work. Period. All of the whiners who want to moan about that being rationing are welcome to go get real private insurance. Funds are not unlimited, and such whiners and moaners need to STFU about rationing already. Let's do it.

Word.

Methinks you're right that we'll see a lot of NP and PA's doing more primary care

And I agree with you that it isn't all bad. The AMA will have to get over this.

It's definitely far from over... this is going to be a cost debacle for years. This is the democrats' Iraq war. I see a mess and things emerging somewhat better in a while. Maybe we'll have a "surge" of Primary care, and maybe we'll help the locals do it better by promoting local solutions and maybe we'll face facts and follow my recommendations for enforcing quality improvement and rationing standards. Or we're seriously on the rocks as a nation, our debt will get downgraded, and we're going to be conquered by Mexico in 25 years, who knows. China wins, though... I'm betting on China.

I couldn't have said it better myself. Pardon me; I'm getting a bit verklempt. <sniff>.

- Bill

[Dana Sheets]

Thankfully, the bill is a first step and not a final product. However, the bill does establish a framework for future adjustments to access and payment for health care which is a conversation that had been held up for far too long. Even if nobody like the ingredients list, at least everyone is now in the kitchen cooking.

I fully expect that health care reform will continue at the legislative level for the rest of my life. Which, IMO, is much better than simply debating health care reform.

[Bill Glasheen]

the bill does establish a framework for future adjustments to access and payment for health care which is a conversation that had been held up for far too long. Even if nobody like the ingredients list, at least everyone is now in the kitchen cooking.

Requiring people to purchase insurance is a show-stopper for me, Dana. It grates against my libertarian sensibilities. And I am not alone.

Some years back, I worked at the local BCBS plan with a fellow who had a PhD in English. He was an entertaining lad in the sense that he had the IQ of a college professor and the street smarts of the common man on Main Street. He had a special way of seeing and articulating what we all knew to be true.

There was a saying he had about "great ideas" that aren't so great in practice. He likened it to a "wonderful" mix coming out of a dog food factory that was to be fed to the hounds back in the kennel. In his own words... "Great idea, but... dogs won't eat the stuff!"

Sorry, my dear friend, but I'm not eating a damned thing coming out of that kitchen. As a matter of principle, I'd rather starve.

This bill does nothing to control cost. And if cost isn't controlled, then NOBODY will be able to afford the mess we have. And sorry, but taking money away from seniors (who ALREADY PAID FOR their retirement health care) to fund those who don't earn enough money isn't my idea of cost containment. That's the absolute worst kind of wealth redistribution. Coming 100 percent from a party that claims to fight for the disenfranchised, it's shockingly callous.

Obama tosses granny off the cliff

This bill does little to nothing to improve quality.

All this bill does is force people to pay into a broken system, and take money away from the wealthy and the elderly. Does that sound like a framework to you?

I'm not biting.

**

Obviously someone is, but that isn't necessarily a good thing.



- Bill

** I wish I was that cute...

[Valkenar]

However I don't want to have to subsidize YOUR choices. That's only fair, particularly since a good portion of the population believes that abortion is morally reprehensible.

I disagree. If abortion is a legal medical procedure it should be part of the healthcare system. If you want to outlaw abortion that's a different discussion. Exempting abortion is tantamount to a de-facto ban on it for those that can't afford it out of pocket. And that's wrong on several levels.

Also, there are many choices we're all forced to subsidize. If you're making this argument, then maybe I don't want to pay for anything heart or lung related for anyone who smokes. Maybe I don't want to pay for trauma treatment for anyone who gets in a car accident while speeding.

Finally, do you think an abortion is a more expensive procedure than a delivery? What about paying welfare for who knows how many years? From a cost perspective I'm betting that an abortion is a pretty good deal. Not that I think a cost perspective is the right perspective to look at this from. But if you're making an "oh noes my precious monies" argument, you might consider the costs of *not* performing that abortion. What's more damaging to life-long productivity than having a baby at 17? Again, not that I think GDP is the right measuring stick for the advisability of abortion funding to begin with.

[Bill Glasheen]

I'm surprised, Justin, that you don't show the least bit of empathy for someone who finds abortion to be a moral dilemma.

None of your other arguments hold. You should know however that the medical system already penalizes people who make bad choices. Still an alcoholic? Don't expect the system to supply you with a liver when yours goes bad.

I have no problem denying the PUBLIC FUNDING of some types of health care to people who engage in risky activity. You're a liberal, right? Check out the health care system in the UK. They're not so kind to people who make bad choices as well.

Finally, do you think an abortion is a more expensive procedure than a delivery? What about paying welfare for who knows how many years? From a cost perspective I'm betting that an abortion is a pretty good deal.

Gotcha!!!!

My dear friend... I have a piece of literature for you to read.

A Modest Proposal

Do you like your Irish broiled or fried?

- Bill

[Dana Sheets]

Ah Bill, why so pessimistic? I think you should attend TedMed.
http://www.tedmed.com/what

Look into the crystal ball with me...
At some point in the next 5-30 years a group of fiscal conservatives will control the house, senate, and the presidency. The graying voting block won't want to let the new benefits go away but faced with a complete withdrawl or significant reduction of the entitlement system, cost controls will be added to health care reform AND we'll already have exchange programs in place.

That ain't so bad, is it?