Saturday, November 7, 2009

Health Reform: "We The People," Not "We The Government"

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

United States Constitution, 1787

Governments derive their just power from the consent of the government.

Declaration of Independence, 1776

That government is best that governs least.

Thoreau, Civil Disabedience, 1849

November 7, !1:30 AM - As I write this on a beautiful Saturday afternoon, Democrats and Republicans are vigorously debating HR 3962, the House health care reform bill. Speaker Pelosi is counting the votes to see if Democrats have 218 votes for passage. President Obama is there for a pep rally to cheer on Democrat troops.

One “No” Vote

Personally I would vote “No” on H.R. 3962 because I believe “We the People “ – health consumers, patients, physicians, caregivers of every ilk, and the American public – those of us on the ground, can decide what is best for our general Welfare” and can best secure “the Blessings of our Liberty and our Posterity,” rather than elitists and politicians in faraway Washington. With a current projected national debt of $9 trillion by 2019, our posterity is up for grabs.

It is “We the People” giving and receiving care, rather than far removed third party Washington technocrats and bureaucrats who should make the determinations and decisions that effect our health. My opinion is not, of course, universal. As Donald Broder, MD, a retired California physician, remarked in the today's New York Times,”Only a health care system that provides each and every one of us with the health care we need will be good enough. We need a single-payer, Medicare-for-all system.”

I am also acutely aware, that the fate of President Obama's presidency may hinge on tonight's vote and that he has said if the U.S. had it to do over again, he would favor a Canadian-type center. This does not surprise me. Obama is a center-left president in a center-right country, which is why there is so much suspense about the outcome of the vote, which may occur this evening.

Consumer-Driven, Not Government-Driven Care

I am a believer in consumer-driven care, also referred to a patient-centered care, and Health Savings Accounts, which encourage health consumers to join High Deductible Plans, in which ½ the premiums are paid by employers, and which tax-free money not spent is set aside for retirement.

Compromise of General Welfare and Freedoms

Furthermore, as I browse through the 1990 page document known as H.R. 3962, I am genuinely concerned the bill compromises the general Welfare and Freedoms of “We the People": The following examples of these compromises and loss of freedoms are from a November 7 WSJ article, “What the Pelosi-Health Care Bill Really Says” by Betsy McCaughey, former lieutenant governor of New York.

• Sec. 202 (p. 91-92) of HR 3962 requires Americans to enroll in a "qualified plan." Your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit. In other words, you lose the “Liberty” to pick your own plan, independent of government control.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

• Sec. 303 (pp. 167-168) the "qualified plan" will be of a "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill. The government, in short, dictates and controls all benefits.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement. This means you, but not illegal immigrants, will now under surveillance by the IRS.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less. This means businesses march to the beat of government, i.e, the government “mandates” what they can or cannot do and what they must pay. An 8% payroll tax will put many small businesses out of business.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward a "medical home." A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

.Sec, 115801169 (pages 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida. The government believes it can homogenize and standardize costs, no matter the magnitude of different cultures, different costs of doing business, and different levels of sickness. It is a fool's errand.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). This will result in reductions in optional benefits such as vision and dental care.

• Sec. 1402 (p. 756) says that results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.

• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

What Will This All Cost?

It will likely cost $1.3 trillion to cover 36 million more uninsured and up to 96% of the population, to be paid for by taxing millionaires and companies that form the medical-industrial complex (health plans, medical device makers, drug companies) hikes in middle-class taxes, and individual and employer mandates with accompanying penalties and fines for not complying with government regulations.

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

To sum up, H.R 3962 assumes government knows best. Big Brother, it follows, know what is good for you, your health care pan should be , and how you should spend your health care money. This violates the principles of our Founding Fathers, who believed government should work for you, not you work for the government.

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