Cutting More "Objectively Standard" Lies About the Health Care Bill

(Note: The original "Deconstruction" is still here...)

Apparently, they haven't figured out we're onto them.  

What follows is from an e-mail sent by a reader. The original comes from a blog entitled "The Objective Standard." It's an Ayn Randian type blog that simply has a problem with the government doing anything in general, so it's somewhat different from a typical right wing rant. Although it's still plenty dishonest.First of all, the title of the blog is insane. I'm not sure they even understand what an "objective standard" is. Frankly, I'm not even sure such a thing is possible. Facts are objective; standards tend not to be.They may TRY to be objective, but the fact is, pretty much all standards are subjective at their heart. But check out the title of the article. He purports to tell his readers what HR 3200 actually says, but then proceeds to leave out huge sections of the bill, removes any context from the sections of the bill he cites, and then mischaracterizes what the bill says.

 

As usual, I don't expect anyone to take my word for anything. Follow along with the bill itself. It's important that you know what's in it.

As usual, my comments are in red... By request, I darkened the color. Hope you like it.

 

The Health Care Bill: What HR 3200, ‘'America's Affordable Health Choices Act of 2009,' Says

Posted by John David Lewis at 3:26 PM

What does the bill, HR 3200, short-titled ‘‘America’s Affordable Health Choices Act of 2009,” actually say about major health care issues? I here pose a few questions in no particular order, citing relevant passages and offering a brief evaluation after each set of passages.

 

This bill is 1017 pages long. It is knee-deep in legalese and references to other federal regulations and laws.I have only touched pieces of the bill here. For instance, I have not considered the establishment of (1) “Health Choices Commissioner” (Section 141); (2) a “Health Insurance Exchange,” (Section 201), basically a government run insurance scheme to coordinate all insurance activity; (3) a Public Health Insurance Option (Section 221); and similar provisions.  

 

This is the evaluation of someone who is neither a physician nor a legal professional. I am citizen, concerned about this bill’s effects on my freedom as an American. I would rather have used my time in other ways—but this is too important to ignore.

 

He really should have ignored it.  

I'm not a physician, and I am not a lawyer, although my many years as a paralegal with huge law firms has given me the ability to read more "legalese" than the average person. But strangely, the bill doesn't contain as much "legalese" as one would think. It essentially creates a formula for creating a public insurance system, and forces private insurance to operate in a competitive environment. You've seen my rebuttals to their lies before; they're not difficult to understand at all. And when you look at my rebuttals, and compare them with what the bill actually says, you can tell who's not telling the truth.

 

We may answer one question up front: How will the government pay for all this? Higher taxes, more borrowing, printing money, cutting payments, or rationing services—there are no other options.  We will all pay for this, enrolled in the government “option” or not.

 

As you can see, he prefaces his deception with a ridiculous question that only a "true believer" would ask. How will the government pay for it? Before you ask that question, however, you have to ask, "who's paying for it now?" WE pay for government, and WE pay for private health insurance. To separate the two is to make a distinction without a difference. WE pay both. Right now, we pay $2.4 trillion a year for health care, and a large portion of that is because private insurance companies refuse to cover people who might actually use their insurance, and because they refuse to pay for health care whenever possible.  

This is the distinction these people make that forms the heart of the cognitive dissonance in the opposition to health insurance reform. They are trying to convince people that paying $500 a month to the government is somehow MORE WRONG than paying $1500 a month to an insurance company. On what planet does that make sense to anyone?  In what parallel universe is $1500 per month in health insurance premiums LESS MONEY than a $500 tax increase, IF you decide to choose the public option?

 

(All bold type within the text of the bill is added for emphasis.)

1. WILL THE PLAN RATION MEDICAL CARE?

This is what the bill says, pages 284-288, SEC. 1151. REDUCING POTENTIALLY PREVENTABLE HOSPITAL READMISSIONS:

 (ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

and, under “Definitions”:

(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .

and:

(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.

and:

(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of— . . .

(C) the measures of readmissions . . .

 

Okay, first of all, for those of you following along, start on page 280, not 284. And alarm bells should be going off at all of the ellipses above. Not only that, but note that he starts with the title, and then skips down to subsection (ii), and then jumps to the "definitions' section, where we see more ellipses. 

Here is his "analysis."

 

 

EVALUATION OF THE PASSAGES:

1. This section amends the Social Security Act

 

Much of the entire BILL amends parts of the Social Security Act, because Medicare is under the Social Security Act.I'm not sure why this matters much.

 

2. The government has the power to determine what constitutes an “applicable [medical] condition.”

 

Well, since the bill establishes a public insurance program, one would think "the government" would have the power to determine what constitutes an "applicable [medical] condition." I mean, if you were to choose a CIGNA plan instead of the public plan, you would expect CIGNA to decide what constituted a "applicable [medical] condition," right?  That's just one of this article's "duh" moments.

But back to the section he's quoting out of context. It has to do with high volume procedures that are essentially preformed somewhat carelessly, to the point that they have to be redone. And that's being kind. It is not unheard-of to have less-than-scrupulous physicians undertreat patients, so that they can be readmitted, and Medicare recharged, as well.

 

Here's what he included above:  

(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary . . .    

Here's that the section says, sans ellipsis:  

‘‘(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary among conditions and procedures for which—

‘‘(i) readmissions (as defined in subparagraph (E)) that represent conditions or procedures that are high volume or high  expenditures under this title (or other criteria specified by the Secretary); and

'‘(ii) measures of such readmissions— ‘‘(I) have been endorsed by the entity with a contract under section 1890(a); and

‘‘(II) such endorsed measures have appropriate exclusions for readmissions that are unrelated to the prior discharge (such as a planned readmission or transfer to another applicable hospital).

 

Wow. Removing that ellipsis changed everything, didn't it? Look how much he left out; you know, like the explanation. This section refers to paying for patients who are readmitted through doctor carelessness or lack of thoroughness, or in some cases, outright fraud. Note that, at the end, they distinguish between a preventable readmission, and those readmissions that are perfectly fine. That should have been a clue.

 

3. The government has the power to determine who is allowed readmission into a hospital.

 

Well, obviously, that's not true. They don't determine who gets readmitted; they simply reduce their payment amount for hospitals who have to continually readmit the same patients for the same ailments.  If they had that sort of power, they wouldn't have to reduce payments for preventable readmissions, now, would they? Think a little, dude.

 

4. This determination will be made by statistics: when enough people have been discharged for the same condition, an individual may be readmitted.

 

5. This is government rationing, pure, simple, and straight up.

 

 

I have dealt this this section previously. What it deals with is READMISSIONS. Specifically, preventive readmissions. They have nothing to do with rationing care; in fact, the policy in the section above is a very successful policy that has been part of Medicare for many years, and represents the exact OPPOSITE of health care rationing, because it's designed to encourage doctors to do a full diagnosis and a complete treatment THE FIRST TIME, because each time a patient is readmitted for a condition that is deemed preventable through proper treatment, the doctor makes less money. It encourages thoroughness, which is the opposite of rationing.  

I'm puzzled by this sudden concern over rationing, anyway. Every single one of us knows at least one other person whose private insurance denied a claim, or overrode a doctor's medical decision, because such a treatment was "experimental," or "too expensive," or was the result of a "pre-existing condition." That's rationing, folks. And there is NOTHING in this bill that does that. In fact, it does the opposite.  It penalizes hospitals that do NOT fully treat their patients, and it forbids insurance companies from not covering anything they promise to cover in their contract.

In other words, rather than causing "health care rationing," this bill actually prevents the rationing that goes on now.

 

6. There can be no judicial review of decisions made here. The Secretary is above the courts.

  Have you noticed how the same lies keep on coming up? This guy says this same thing several times in this same article. In fact, question 9 is all about this. The cognitive dissonance common to the right causes them to think that Congress can write a bill that simply suspends the Constitutional separation of powers.  

This is, of course, truly asinine But think about the conditions of the healthy insurance system right now. In reality, that you can pretty much NEVER sue a private insurance company, no matter what they do. Have you ever read a health insurance contract? Wait; of course you haven't, because the insurance companies contract with your employer, and NOT YOU. You don't get to see the contract in most cases. Of course, most contracts contain a clause that forbids you from suing them for anything. If they make a decision you don't like, you can appeal to them. If you don't like their decision on appeal, you're required to go to an arbitrator. And after you've spent all of your money on a lawyer to help you before an arbitrator (assuming you don't die in the interim), then you can give your lawyer even more money and appeal. Again; if you live long enough, and frankly, private insurance doesn't care if you die, because they won't pay for the funeral, anyway.

Now, here's his "condensed" version of the section on judicial review:

 

(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of— . . .

(C) the measures of readmissions . . .

 

Here's what it actually says:

‘‘(6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of—

‘‘(A) the determination of base operating DRG payment amounts;

‘‘(B) the methodology for determining the adjustment factor under paragraph (3), including excess readmissions ratio under paragraph (4)(C), aggregate payments for excess readmissions under paragraph (4)(A), and aggregate payments for all discharges under paragraph (4)(B), and applicable periods and applicable conditions under paragraph (5);

‘‘(C) the measures of readmissions as described in paragraph (5)(A)(ii); and

‘‘(D) the determination of a targeted hospital under paragraph (8)(B)(i), the increase in payment under paragraph (8)(B)(ii), the aggregate cap under paragraph (8)(C)(i), the hospital-specific limit under paragraph (8)(C)(ii), and the form of payment made by the Secretary under paragraph (8)(D).

The above ACTUALLY says that, once providers agree to abide by the rules, they can't sue about the rules and tie up the courts. This clause appears in just about every section that deals with data. It simply prevents health care delivery people from tying up the courts over data interpretation. Period.That's all. Wasn't that simple?

 

7. The plan also allows the government to prohibit hospitals from expanding without federal permission: page 317-318.

 

Can you say "non sequitur"??  

Here's what I wrote about this section the last time. It still fits:  

The bill prohibits doctors from referring patients to hospitals in which they have a significant ownership interest in,  without disclosing to the patient that he indeed has an ownership stake in the hospital. The government also prohibits "self-referral" under most circumstances. That's actually fair to all of the other hospitals. There is absolutely zero prohibition on doctors having ownership of hospitals.  What this tool is citing has to do with rural areas. It's to prevent one physician from effectively controlling all aspects of health care in a region, where possible.

 

2. Will the plan punish Americans who try to opt out?

What the bill says, pages 167-168, section 401, TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE:

(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—

(1) the taxpayer’s modified adjusted gross income for the taxable year, over

(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. . . .

EVALUATION OF THE PASSAGE:

1. This section amends the Internal Revenue Code.
2. Anyone caught without acceptable coverage and not in the government plan will pay a special tax.
3. The IRS will be a major enforcement mechanism for the plan.

 

Once more, beware the ellipsis. Here's what it actually says:  

‘‘SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE. ‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed  a tax equal to 2.5 percent of the excess of—

‘‘(1) the taxpayer’s modified adjusted gross income for the taxable year, over

‘‘(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. ‘‘(b) LIMITATIONS.—

‘‘(1) TAX LIMITED TO AVERAGE PREMIUM.— 

‘‘(A) IN GENERAL.—The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year. ‘‘(B) APPLICABLE NATIONAL AVERAGE PREMIUM.—

‘‘(i) IN GENERAL.—For purposes of subparagraph (A), the ‘applicable national average premium’ means, with respect to any taxable year, the average premium (as determined by the Secretary, in coordination with the Health Choices Commissioner) for self-only coverage under a basic  plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins.

‘‘(ii) FAILURE TO PROVIDE COVERAGE FOR MORE THAN ONE INDIVIDUAL.—In the case of any taxpayer who fails to meet the requirements of subsection (e) with respect to more than one individual during the taxable year, clause (i) shall be applied by substituting ‘family coverage’ for ‘self-only coverage’.

Okay, so why is this wrong? Yes, it amends the Internal Revenue Code. And of course, the IRS enforces it. And for once, it's not a lie.But I also don't see the relevance.

 

But it's not a "special tax" on "anyone caught without acceptable coverage" at all. The only people who will pay any tax at all are those with the means to pay for coverage who refuse to do so. The poor and working class (up to 3 times the poverty rate) will receive subsidized coverage at an amount they can easily afford, based on their income. Everyone will have access to affordable health care coverage.  But if they choose not to participate, and pay into the insurance pool, they will have to pay a little something, to cover emergencies.Which fills a major glaring hole in the current insurance system.

 

See, here's the problem.

 

The reason our system is collapsing under its own weight is because health care is because so may people are using an ER as primary care, and because uninsured people contract illnesses and have accidents. If they don't carry insurance because no one will sell it to them, that’s one thing. If they do so because they think they're invincible, that's another. The fact of the matter is, if you slip on the ice and crack your skull, and you have no insurance and no way to pay for 3 days in the ICU and a couple of brain scans, someone has to pay the bill. And 2.5% isn't a hell of a lot, anyway. For an individual with an AGI of $100,000 a year (that's after deductions, so such a person may have total income of as much as $130,000), the total bill will be $2,500. Bummer. 

 

3. what constitutes “acceptable” coverage?

 

This section is too long to simply re-paste , so I'll just urge you to read the entire section in the bill. I will, however, fill in some gaps, marked by those dreaded ellipses.

 

Here is what the bill says, pages 26-30, SEC. 122, ESSENTIAL BENEFITS PACKAGE DEFINED:

 (a) IN GENERAL.—In this division, the term ‘‘essential benefits package’’ means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security . . .

 

that—

(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;

(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);

(3) does not impose any annual or lifetime limit on the coverage of covered health care items and

services;

(4) complies with section 115(a) (relating to network adequacy); and

(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid

Services, to the average prevailing employer-sponsored coverage.

 

 

Now, before we continue, what does the above say?

It creates minimal standards for ANY health insurance plan. And what are they based on? They're based on standards that should already in place in the health insurance industry today. Now, all insurance companies will have to live up to certain standards up front. But there's another reason why it makes sense to have minimum standards.

Have you ever seen those plans they sell on late night TV? You know, where you can get "real health insurance" for about $200 per month or something like that? Have you ever checked the benefits? They don't cover squat. Which means, if you get sick and incur $50,000 in bills, they'll cover the first $5,000 or so, and the rest of us have to pick up the slack. The purpose of this bill is to get rid of the slack, and see to it that every bill gets paid, so that premiums don't have to double again in the next decade.

 

 

(b) MINIMUM SERVICES TO BE COVERED.—The items and services described in this subsection are the following:

(1) Hospitalization.

(2) Outpatient hospital and outpatient clinic services . . .

 

(2) Outpatient hospital and outpatient clinic services, including emergency department services.

 

(3) Professional services of physicians and other health professionals.

(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care . . .

 

(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 . . .

 

(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 . . .

 

(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.

 

(c) REQUIREMENTS RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .

(3) MINIMUM ACTUARIAL VALUE.—

(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

EVALUATION OF THE PASSAGES:

1.  The bill defines “acceptable coverage” and leaves no room for choice in this regard.

 

This is just insane. It sets minimum requirements for "acceptable coverage," to keep fly-by-night crappy pseudo-insurance companies out of the business, and to make sure you know what you're getting when you buy health insurance. It's a consumer protection that should have been put in place many years ago. As I noted, there are lots of policies out there right now posing as "health insurance," when they're anything but. This would create a standard, so that you know up front what's covered, and what's in the contract you sign.

 

And to say there is "no choice" makes no sense. Right now, almost everyone gets whatever their employer chooses for them. Most employers pay 80% of their premiums, so employees usually have a choice of paying $2500-3500 per year for that policy or paying 3-4 times as much for a policy on their own. For anyone with a household take home income of less than $100,000, that's not much of a choice, is it? This plan places a whole array of choices in front of the employee, and let’s THEM choose. They choose the company (or the public option, if they want); they choose which level of coverage they prefer (this bill mandates that every participating company offer three levels); and they sign a contract themselves with the insurance company, who will be legally and contractually bound to honor.

 

In other words, in order to claim this bill offers "no choice" requires complete ignorance of what this bill creates. And a section mandating minimum standards for insurance coverage isn't going to cut it.

2. By setting a minimum 70%  actuarial value of benefits, the bill makes health plans in which individuals pay for routine services, but carry insurance only for catastrophic events, (such as Health Savings Accounts) illegal.

 

No, it doesn't. Except for the well baby care and preventive services, what in the above list is NOT covered by a catastrophic policy? How much would it cost to add a couple of office visits a year to the mix?

 

That said, I think there should be an adjustment to this. People who carry pointless policies like "catastrophic" policies should have to show financial responsibility to cover the extremely high deductible on such policies. If you carry a policy that doesn't kick in until the bill goes above $20,000, you should be required to post a bond of sorts. (In my opinion, all policies should include some preventive care. People who get the flu should be responsible and go to the doctor; otherwise, the rest of us could catch it from them.

 

 

4. Will the PLAN destroy private health insurance?

Here is what it requires, for businesses with payrolls greater than $400,000 per year. (The bill uses “contribution” to refer to mandatory payments to the government plan.)  Pages 149-150, SEC. 313, EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE

(a) IN GENERAL.—A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of  the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—

(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and

(2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.

 

(The bill then includes a sliding scale of payments for business with less than $400,000 in annual payroll.)

 

(NOTE: They cut out the chart! Why would they do that? Check out #2 below…)

 

The Bill also reserves, for the government, the power to determine an acceptable benefits plan: page 24, SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS.

5 (a) IN GENERAL.—A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.

EVALUATION OF THE PASSAGES:

1. The bill does not prohibit a person from buying private insurance.

 

So far, so good. This is true. Good for them.

 

2. Small businesses—with say 8-10 employees—will either have to provide insurance to federal standards, or pay an 8% payroll tax. Business costs for health care are higher than this, especially considering administrative costs. Any competitive business that tries to stay with a private plan will face a payroll disadvantage against competitors who go with the government “option.”

 

Once more, they just can't get over this whole tax thing, and they simply cannot tell the truth about it.  

 

How many small businesses with 8-10 employees would you imagine have a payroll of more than $400,000? Because that's the minimum payroll size that would pay 8% of their payroll in taxes. Payrolls of less than $400,000 would pay less. And payrolls of less than $250,000 would pay nothing. In this guy's world, apparently, there are lots of small businesses out there paying their employees $40-50,000 a year, but refusing to pay for health insurance. Does that sound realistic?

The whole point of this bill is to make sure everyone is covered, because universal coverage saves everyone money. Currently, for better or worse, employers provide health insurance for most people. This bill will allow more businesses to provide insurance for their employees without going broke. It will allow businesses to operate on a more level playing field, where they can compete for the best employees without health insurance costs getting in the way.

 

Now, check out the last sentence above. 

It demonstrates a complete lack of understanding of what this health care plan does. It creates a health insurance EXCHANGE. That means every business that offers insurance will have to offer ALL public AND private options available in that area. The EMPLOYEE chooses which plan -- all employers have to offer all plans to all employees. It's the epitome of competition, and an even playing field. ALL small businesses who offer this stuff will be offering the same thing. It will ELIMINATE the current competitive disadvantage small businesses currently feel. That small business that wants to pay its employees $50,000 can now afford to pay for health insurance. 

 

3. The pressure for business owners to terminate the private plans will be enormous.

 

Um, they CANNOT eliminate the private plans. They have to offer all of the plans in the exchange.  In other words, for them to ONLY offer the public plan would be illegal.

 

4. With employers ending plans, millions of Americans will lose their private coverage, and fewer companies will offer it.

 

Once more, they will have to offer all of the plans in the exchange, and ONE of them will HAVE to include the plan they already provide.  The only Americans who will lose their private coverage are those who choose to do so.

 

By the way, doesn't this contradict what he just said in #1 above? If no one is prohibited from buying private insurance, then how are they "losing" it?

 

5. The Commissioner (meaning, always, the bureaucrats) will determine whether a particular network of physicians, hospitals and insurance is acceptable.

 

Gosh, and that never happens under the current system, does it?

Even if what he was saying was true -- and it's not -- if that's a concern, then why is he trying to maintain the status quo?

Has he ever been through "open enrollment"? You remember that; that's the only time of year when you can change your coverage. Not your company, but your coverage. Ever go through that huge directory or that web site, trying to find a "network physician" that you liked, and who was approved by your plan AND who wasn't "full"? Do you know what will change? The only restrictions on choosing a physician will be that he or she is licensed to practice in your state, and is willing to take the money from the public option insurance.  In other words, READ THE BILL, folks; you will have a GREATER choice of doctors with the public option. Of course, since the public option will open up your choices, private insurance will have to do the same to compete. Imagine that… how horrible...

 

6. With private insurance starved, many people enrolled in the government “option” will have no place else to go.

 

There is nothing in this bill that "starves" private insurance companies. What it does is to make them honest, which is something they seem allergic to these days.  Once more; the bill creates an insurance "exchange," wherein every employee will have a list of insurance plans to choose from.

 

5. Does the plan TAX successful Americans more THAN OTHERS?

Here is what the bill says, pages 197-198, SEC. 441. SURCHARGE ON HIGH INCOME INDIVIDUALS

SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.

(a) GENERAL RULE.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—

(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,

(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and

(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.

EVALUATION OF THE PASSAGE:

1. This bill amends the Internal Revenue Code.
2. Tax surcharges  are levied on those with the highest incomes.
3. The plan manipulates the tax code to redistribute their wealth.
4. Successful business owners will bear the highest cost of this plan.

 

At least 2 of these aren't complete lies.

 

As long as I live, I will never understand this concept that taxes are somehow "punishment" for "being successful." Taxes are not a punishment, they're the cost of living in a society. It's called progressive taxation, people! People with the most money pay more in taxes, because they can afford it.  It's logical. The less they pay, the more the rest of us pay. And if you think it's such a "punishment," which would you rather be; head of a household making $50,000 a year and paying 30% in taxes, or head of a household making $5 million, paying 50% in taxes? (And yes, I know they don't pay that much..)

 

If you answered the former, you're so blinded by ideology that you have given up all logical abilities.

 

Yes, the bill amends the Internal Revenue Code. I'm still not sure why that's important.

 

Yes, those tax surcharges are levied on the highest income individuals. An INDIVIDUAL making $350,000 will pay $0.00. An individual making $500,000 will pay a whopping  $1,500!! Be still my heart! That could bankrupt them! An individual making $1 million per year will pay -- hold onto your hats! $9,000!! And the poor, lowly CEO with $3 million  AGI (that's AFTER deductions, folks) will be forced to part with  a whopping  $117,000. If that's enough to get the rich to stop doing that which made them rich, I'd like to know which asylum they're staying in. 

 

This isn't "redistributing wealth" at all. That whole concept is a joke. Not only that, but if they're that rich, they got that way through the hard work of employees, and by implementing this plan, the business that got them rich will save tons of money on health insurance costs. I would also note that the tax is imposed on "taxpayer(s) other than () corporation(s)," meaning "successful business owners" won't be adversely affected by this at all, no matter what. Any sole proprietor who has net income of more than half a million dollars and isn't incorporated is either quite daring or not too bright, so this tax isn't going to affect business at all. 

Seriously, think about this statement:

 

"I'm going to stop making a million dollars every year, because the government wants to take $9,000 to help pay for a public health insurance that will ultimately save me thousands per year per employee."

 

Yeah, that may make sense on some planet. But not this one…

 

6. Does THE PLAN ALLOW THE GOVERNMENT TO set FEES FOR SERVICES?

What it says, page 124, Sec. 223, PAYMENT RATES FOR ITEMS AND SERVICES:

(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient, taking into account the provisions of section 221(a) and the amounts paid for similar health care providers and services under other Exchange-participating health benefits plans.

(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates, including payments to provide for the more efficient delivery of services, such as the initiatives provided for under section 224.

 

I'm not sure why anyone would even ask such a ridiculous question. If the government is running its own insurance plan, one would HOPE they would set the fees they would pay. Do these people think private insurance companies don't pay lower prices than everyone else? Anyway, this one is just odd.

 

Now, in my country, the alphabet doesn't start with (d). Therefore, you get a sense that something's missing, don't you?

 

Here's the paragraph just before section (d):

 

(c) ADMINISTRATIVE PROCESS FOR SETTING RATES.— Chapter 5 of title 5, United States Code shall apply to the process for the initial establishment of payment rates under this section but not to the specific methodology for establishing such rates or the calculation of such rates.

 

And here's the beginning of Section 223:

(A) IN GENERAL.—Except as provided in subparagraph (B) and subsection (b)(1), during Y1, Y2, and Y3, the Secretary shall base the payment rates under this section for services and providers described in paragraph (1) on the payment rates for similar services and providers under parts A and B of Medicare.

 

In other words, they will set rates and prices the same way in this system as they do for anything else. You know, like they set prices for Defense Department contracts.  Which makes this "evaluation" a little strange. Not only that, but they plan to use the same methodology for setting prices as they've used in Medicare for years. Now, these people keep on complaining that Medicare is running out of money. How is it possible for Medicare to run out of money, if the government is paying too little for procedures.

 

Cognitive dissonance, folks. That's what they're all about. They can make no logical sense, because they know this would be a good thing for everyone concerned, but they have to be against it, because their ideology demands it.

 

EVALUATION OF THE PASSAGES:

1. The government’s authority to set payments is basically unlimited.
2. The official will decide what constitutes “excessive,” “deficient,” and “efficient” payments and services.

 

It's unlimited? How is ANY government agency's authority to set payments "unlimited"? The very concept of such a thing is ludicrous. They can't spend money unless it's appropriated by Congress, and even this bill states that they must follow all of the rules in Title 5, Chapter 5. Of course, that was in the part they didn't include above; you know, the paragraph above the section they're trying to use to "prove" the government's supposed "unlimited" power. 

 

There is no such thing as "unlimited government power." I wish these people would learn that. It's called "checks and balances," folks.  The idea that somehow a government bureaucrat can do whatever the hell he wants was the delusion of the Bush Administration; it's not real.

 

Nothing in the above says that anyone involved can just unilaterally decide something. In order for something to be "declared" excessive or deficient, there has to be a standard set in place. He or she can't just decide a payment is too high or too low; there has to be a price range set beforehand. Bureaucrats are pretty much forbidden from acting arbitrarily, because of little things like the Bill of Rights. Of course, private insurance companies currently can be as arbitrary as they'd like.

 

 

7. Will THE PLAN increase the power of government officials to SCRUTINIZE our private affairs?

What it says, pages 195-196, SEC. 431. DISCLOSURES TO CARRY OUT HEALTH INSURANCE EXCHANGE SUBSIDIES.

(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—

(i) taxpayer identity information with respect to such taxpayer,

(ii) the filing status of such taxpayer,

(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),

(iv) the number of dependents of the taxpayer,

(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and

(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.

And, page 145, section 312, EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE:

(3) PROVISION OF INFORMATION.—The employer provides the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.

EVALUATION OF THE PASSAGE:

1. This section amends the Internal Revenue Code
2. The bill opens up income tax return information to federal officials.
3. Any stated “limits” to such information are circumvented by item (v), which allows federal officials to decide what information is needed.
4. Employers are required to report whatever information the government says it needs to enforce the plan.

 

Okay, I'm still puzzled by why amending the Internal Revenue Code is somehow something to worry about.  As for #2, I've dealt with this before. It doesn't really open up much tax return information, as evidenced by the section that says "Such return information shall be limited to--" 

 

But the issue here has to do with means testing. Every government program like this does means testing, and the most accurate method is to take a look at a few key pieces of information on a tax return. What would the alternative be? To ask you to bring in the last six months worth of pay stubs? I would find that far more intrusive. How about checking your bank account and examining every deposit? I don't think I would appreciate that, either. Is this guy saying that people who sign up for an entitlement should just simply be trusted when they say they qualify?

 

In the third item, he notes the "limits," then commits the cardinal sin of assuming that the laws created in this bill will work in a vacuum, apart from every other law and regulation in existence. ALL government officials must comply with privacy and security laws. Your private information is not simply there for the taking, just because someone in the government wants it. Without a warrant or probable cause, no government official can look at any personal information without your permission. Period.  And the section he claims will allow the Secretary to "circumvent" the actual law? It doesn't say that. Did you notice the words "by regulation"?? If more information is needed, someone will have to pass a regulation in order to do so. The Secretary can't do what he/she wants.

 

By the way, even though the above lacks ellipses, for some reason, he left out the next part of Section 431:

‘‘(B) RESTRICTION ON USE OF DISCLOSED INFORMATION.—Return information disclosed under subparagraph (A) may be used by officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, only for the purposes of, and to the extent necessary in, establishing and verifying the appropriate amount of any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009 and providing for the repayment of any such credit which was in excess of such appropriate amount.’

 

In other words, the law prevents anyone from using the limited amount of tax information that you will agree to provide them for anything other than evaluating your qualifications for a health insurance subsidy.

 

Now, let's talk about that last one, shall we?

 

You had to know that, when he started with (3), there was something missing. Here's the section:

 

SEC. 312. EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE.

(a) IN GENERAL.—An employer meets the requirements of this section with respect to an employee if the following requirements are met:

(1) OFFERING OF COVERAGE.—The employer offers the coverage described in section 311(1) either through an Exchange-participating health benefits plan or other than through such a plan.

(2) EMPLOYER REQUIRED CONTRIBUTION.— The employer timely pays to the issuer of such coverage an amount not less than the employer required contribution specified in subsection (b) for such coverage.

(3) PROVISION OF INFORMATION.—The employer provides the Health Choices Commissioner,  the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.

(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).

The new plan requires employers who decide to offer their employees health insurance coverage to pay a certain percentage of the premium, and they are required to provide proof that they are, in fact, paying such a premium. That's all it means. And note that employers CAN decide NOT to participate. They can also choose to offer self-insurance, so long as they are willing to submit to an audit. And as this guy has already pointed out, employers CAN choose to opt out altogether, and simply pay a payroll tax instead, IF their payroll is more than $250,000 per year.

So, yes, IF they CHOOSE to participate in the plan, they are THEN required to provide the information needed to administer the plan. And why wouldn't they? Have you ever heard of an employer taking money for health insurance out of his employees' paychecks every payday, and pocketing the money, and the employee not finding out they're not covered until they went to make a claim? I have. I also remember working for at least one employer who was taking taxes out of my pay every week, but wasn't submitting the money to the IRS.

 

In other words, wouldn't it be nice to know that, if your employer says you have coverage, you actually have coverage? If the government is insuring you, doesn't it make sense that the government KNOW it's insuring you? For that matter, if CIGNA is insuring you, wouldn't it make sense that your employer tell CIGNA?

 

 

8. Does the plan automatically enroll Americans in the GOVERNMENT plan?

What it says, page 102, Section 205, Outreach and enrollment of Exchange-eligible individuals and employers in Exchange-participating health benefits plan:

(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.

And, page 145, section 312:

(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).

EVALUATION OF THE PASSAGES:

1. Do nothing and you are in.
2. Employers are responsible for automatically enrolling people who still work.

 

This is just a plain lie. First of all, not everyone is Medicaid eligible, so automatic enrollment of everyone who, say applies for and receives an Earned Income Tax Credit is not exactly a commie plot to force people into insurance. It's an acknowledgement that people pay taxes for services, and that they should receive those services.

 

But note the second part. You'll recognize it, because it's part of the section he left out of Question 7. Put it in context. As noted by this very same author, those employers who choose not to enroll employees may be subject to a payroll tax. He says so above, right? So, employers aren't actually REQUIRED to provide insurance.  Not only that, but it mentions "subsection ( c)." Gee… what could that subsection say, do you think?

 

(c) AUTOMATIC ENROLLMENT FOR EMPLOYER SPONSORED HEALTH BENEFITS.—

(1) IN GENERAL.—The requirement of this subsection with respect to an employer and an employee is that the employer automatically enroll suchs (sic) employee into the employment-based health benefits plan for individual coverage under the plan option with the lowest applicable employee premium.

(2) OPT-OUT.—In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer. An employer shall provide an employee with a 30-day period to make such an affirmative election before the employer may automatically enroll the employee in such a plan.

 

You'll note two things about this section. First is, the autoenrollment is for the cheapest available plan, which could very well be a private insurance plan.  The second is the ability of the employee to opt out of coverage altogether.  I would also urge everyone to go read this section of the bill, especially the section after this, which explains every employer's disclosure requirements.  Yes, that's right; they have to disclose everything they do, and the employee has to sign off on everything they do. During the orientation, every new employee will get to choose his health insurance plan, and won't have to sign anything else, until he or she decides to change it. How terrible, huh?

 

 

9. Does THE PLAN exempt federal OFFICIALS from COURT REVIEW?

What it says, page 124, Section 223, PAYMENT RATES FOR ITEMS AND SERVICES:

(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.

And, page 256, SEC. 1123. PAYMENTS FOR EFFICIENT AREAS.

(C) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise, respecting—

(i) the identification of a county or other area under subparagraph (A); or

(ii) the assignment of a postal ZIP Code to a county or other area under subparagraph (B).

EVALUATION OF THE PASSAGES:

1. Sec. 1123 amends the Social Security Act, to allow the Secretary to identify areas of the country that underutilize the government’s plan “based on per capita spending.”
2. Parts of the plan are set above the review of the courts.

 

I'm really sick of this question. It is not possible for any federal law to exempt anyone in the federal government from Judicial review. The ONLY thing that is actually set aside as not being subject to judicial review is the data used to determine such things as overpayments or underpayments. Go check out these sections in the bill, and you'll see that there are actually sections before and after (f) and ( C).

 

That's the bottom line in all of this, folks. When you see crap like this, and it seems a little hinky, go read the section of the bill.You'll usually find out that it's a whole LOT hinky.