Questions for your health care town hall: Sec. 1401 and miscellany

posted at 8:47 am on August 12, 2009 by King Banaian

I am going to skip ahead in these notes. Diminishing returns set in; much of the middle third of H.R. 3200 are directives of what services get covered, who can provide, how much gets paid, etc. I’m not a health economist — there are many portions of this review that I frankly prefer to outsource to economists like Keith Hennessey who has worked on this topic much longer. But I do want to say a few other things here and then review comparative effectiveness research.

A few preliminaries. First, I apologize for length. I did intentionally make yesterday’s post long (over 1800 words) so you could see how dense and incomprehensible the language is. It’s roughly 22 times the size of the U.S. Constitution. That should strike one as a warning. (It’s also four times the size of the Patient’s Choice Act; I wish the latter could be smaller.)

In the comments was reference to the home visitation section of the bill. In the middle of this was a reference that I want to highlight:

This is a statement that runs throughout the 1,100 pages and bothers me every time I see it:

(4) OTHER INFORMATION.—Such other information as the Secretary may require.

By my count, 13 times. I want to make sure you ask this question, and I will make it simple for those worried my questions are too long: Senator/Congressperson, what oversight does the Congress expect to have over decisions of the HHS secretary? Do you have any plans to put more oversight into the bill? Democrats, I expect, will answer yes. But this bill is not amendable into something good. So if you hear them say that, you know they aren’t going to do the right thing, which is to kill this thing dead.

I’d also like to quickly dismiss the concern over Sec. 1233, which provides a monetary incentive for health care providers to offer people end-of-life counseling. I’d ask you this: Suppose it was your private insurance provider who was incentivizing the counseling. Would you object? I think it’s hard for a doctor, trained to save lives, to talk about what happens when they decide you can’t be saved. I’m going to go out on a limb — you’re welcome to saw it from under me — to say this service is underprovided in the private sector. And yet there’s an incentive problem at the end of life, both from legal liability and moral standpoints. This may be a place wherePigou is welcome.

OK, on to Sec. 1401, which adds to the Social Security Act:

Sec. 1181. (a) Center for Comparative Effectiveness Research Established-
`(1) IN GENERAL- The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the `Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.
`(2) DUTIES- The Center shall–
`(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;
`(B) conduct and support systematic reviews of clinical research, including original research conducted subsequent to the date of the enactment of this section;
`(C) continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies, and use such methodologies appropriately;
`(D) submit to the Comparative Effectiveness Research Commission, the Secretary, and Congress appropriate relevant reports described in subsection (d)(2); and
`(E) encourage, as appropriate, the development and use of clinical registries and the development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts, and other forms of electronic health data.

It runs on for pages defining an oversight committee, composition of the committee, terms and compensation, etc. The oversight committee, called the “Comparative Effectiveness Research Commission” will disseminate “the findings of research conducted and supported under this section that enables clinicians, patients, consumers, and payers to make more informed health care decisions that improve quality and value.” That “and payers” part I emphasized because that includes the government and its new Health Choices Administration.

So some questions for your senator or congressperson:

  1. What will you do with the results of the Comparative Effectiveness Research Commission?
  2. Will these results be used in redefining the qualified insurance package I can get? That is, suppose my insurer looks at those results and doesn’t change funding for certain treatments. Will the government make them do so?
  3. There are private groups doing comparative effectiveness research. Insurers no doubt do much of this. Why do we need a government agency to do it? Is this a good use of our money?
  4. Relatedly, wasn’t there a billion spent on this in the stimulus act?
  5. To what extent will the commission consider cost in its analysis? Uwe Reinhardt, an advisor during the Hillarycare debate, wrings his hands over people spending too much on their health care. Do you worry about this?
  6. Do you have any evidence that this will save money? CBO says not before 2019.

I may have one more of these in me; there is the “waste, fraud and abuse” parts of the act that I find humorous, actually. But you should have plenty of questions to ask now that are specific. If you want any more, Sen Tom Coburn has ten more.  (And I kept the word count under 1000!)

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Death panels

petefrt on August 12, 2009 at 8:49 AM

I’d also like to quickly dismiss the concern over Sec. 1233, which provides a monetary incentive for health care providers to offer people end-of-life counseling.

I think it is a problem because health care providers are going to pay attention to that which they can bill for. I’d agree that it is hard for this group to talk about options but that doesn’t mean I want them to get a referral fee for turning grandma over to the death squads.

A bit of hyperbole in the above comment but the fact of the matter is that government paying for end-of-life services is simply the entry into more thorny issues like state-funded euthenasia. The dynamic changes when the healthcare system focuses on end-of-life issues instead of maintaining a focus on saving lives.

highhopes on August 12, 2009 at 8:56 AM

The thing I have the most trouble understanding from the right wing POV is why you guys have a problem with government trying to control the cost of providing health care, but you apparently have no trouble at all with insurance companies denying coverage, dropping subscribers, refusing to pay claims, etc.

Isn’t THAT “rationing”?

bschmalfeldt on August 12, 2009 at 8:57 AM

Congressperson, “WHY ARE YOU LYING TO ME?!!?”

SouthernGent on August 12, 2009 at 9:00 AM

The most telling will be asking a question about specifics in the bill, or reciting some portion of it, and see the reaction of the congressman. I bet more than half of them did not read the whole bill, nor passed 30 pages.

jencab on August 12, 2009 at 9:06 AM

The thing I have the most trouble understanding from the right wing POV is why you guys have a problem with government trying to control the cost of providing health care, but you apparently have no trouble at all with insurance companies denying coverage, dropping subscribers, refusing to pay claims, etc.

Isn’t THAT “rationing”?

bschmalfeldt on August 12, 2009 at 8:57 AM

Your logic is diluted and inaccurate. There is a significant difference between whether a procedure or illness is covered under an existing insurance policy, versus an act by the government to deny you care based on their determination of your future worth to society and the cost effectiveness of your survival.

rplat on August 12, 2009 at 9:07 AM

Isn’t THAT “rationing”?

bschmalfeldt on August 12, 2009 at 8:57 AM

Rationing is one of those words that gets batted around without those doing the batting understanding what they are saying. Rationing is part of any system where supply does not equal demand. In fee-for-service healthcare, the rationing occurs by monetary means (those that can afford the treatment, priced at market demand, will get it and those who cannot afford the treatment will not). In a managed care system, rationing and cost reduction comes from managing risk and limiting coverage.

The problem with the plan put forth by the filthy liar in the White House and his corrupt party is that it demands Caddilac health coverage for all but has yet to spell out how to pay for all these added benefits, where the health professionals will come for to staff the massive infusion of new mandatory clients of Obamacare, and most importantly who gets to make the health decisions. When the rat bastard traitor can answer these questions, then it will be time to talk about issues like level of service.

highhopes on August 12, 2009 at 9:08 AM

Isn’t THAT “rationing”?

bschmalfeldt on August 12, 2009 at 8:57 AM

No. That’s the free market system at work — yes it’s cumbersome and takes some initiative on the part of the insured BUT there are methods of recourse — BUT under a gov’t run system once the “death panel” has spoken where can one appeal?

The “public option” will work as well as the USPS — Barry said as much!

rebuzz on August 12, 2009 at 9:08 AM

Let’s just end all of this frivolous debate and run the health care system like the post office. Long lines, surly service, packages not arriving at their destinations, packagaes mishandled, dead letters and so on.

End of life planning is very important. Everyone should take responsibility for themselves to take care of this, but I would not want it to be legislated. I’ll do it just fine on my own thank you.

Thanks for all of your great posts and analysis. They are fabulous and I am learning a lot. The more I learn the more frightening it really is. I will definitely be in need of a red pill soon!

kringeesmom on August 12, 2009 at 9:10 AM

The thing I have the most trouble understanding from the right wing POV is why you guys have a problem with government trying to control the cost of providing health care, but you apparently have no trouble at all with insurance companies denying coverage, dropping subscribers, refusing to pay claims, etc.

Isn’t THAT “rationing”?

bschmalfeldt on August 12, 2009 at 8:57 AM

1. Insurance is a contract. It is also a competitive industry. If you don’t like your contract, you are free to shop elsewhere.

2. If you seriously believe your insurance company is in breach of contract, we have these amazing institutions called courts where we may sue for cause.

3. Government is not competitive. If you don’t like your government you probably can’t change it.

4. It is also difficult or impossible to sue the government as they are legally immune in many kinds of situations.

jwolf on August 12, 2009 at 9:10 AM

my congressman, Dem, Tom Perriello, 5th CD, Va., is probably a smart guy–he is a lawyer & he went to Yale.

however, to fully comprehend this bill takes longer than the hours to read just the 1,000 pages of it. the bill references all kinds of other bills/statutes& you must have the whole US Code handy along with all SC decisions to see if this bill is unconstitutional in whole or in part.

so even the smartest guy up there can’t digest this in a single reading.

kelley in virginia on August 12, 2009 at 9:10 AM

“…as the Secretary may require.”
That is an invitation to unchecked power and potential abuse.
The Obama plan is going to create a two class healthcare system. One that will be outrageously expensive, affordable only to rich people and privelaged government officials, and one that will be cheap but deliver terrible care.

SaveUS on August 12, 2009 at 9:10 AM

The thing I have the most trouble understanding from the right wing POV is why you guys have a problem with government trying to control the cost of providing health care, but you apparently have no trouble at all with insurance companies denying coverage, dropping subscribers, refusing to pay claims, etc.

Isn’t THAT “rationing”?

There is a bug difference between the insurance company of your choice saying “No” and the government saying “No”. I can choose my insurance policy by looking at the reputation of the company and the terms of the policy itself. I can change if I want. My policy is a legally binding agreement between two voluntary parties. With a government monopoly I have no recourse and no choice.

ksm on August 12, 2009 at 9:11 AM

I bet more than half of them did not read the whole bill, nor passed 30 pages.

jencab on August 12, 2009 at 9:06 AM

That’s a big part of the problem. There isn’t one bill there are something like five and the one (of two) the Senate has been working on are vastly different from the ones from the House (all essentially revisions to Waxman’s bill).

McCaskill and Cardin both evaded answering specific questions in their town halls by stating, somewhat correctly, that the provision was part of the House bill and not the bill they have to vote on. It’s a cop out because if this eventually gets out of joint committee then they will end up voting on federally funding abortions and some of the stuff they can momentarily say isn’t even being discussed in Congress.

highhopes on August 12, 2009 at 9:13 AM

The way to catch these dopes is to say something about the bill that doesn’t exist and see what sort of answer you get.

“Can you tell me why the bill includes a provision for tattooing preschoolers?”

“Uhhh…well there is good reason to do that..uhh…”

Bishop on August 12, 2009 at 9:13 AM

6.Do you have any evidence that this will save money? CBO says not before 2019.

How can “save money” and Democrat legislation be used in the same sentence?

7. Will lieing to your constituents be funded by the NEA?

Rovin on August 12, 2009 at 9:13 AM

so even the smartest guy up there can’t digest this in a single reading.

kelley in virginia on August 12, 2009 at 9:10 AM

Which is why I consider it malfeasance that the filthy liar in the White House and his party attempted to get this signed into law in three weeks.

highhopes on August 12, 2009 at 9:16 AM

You know its bad when the president has to come out and say he believes death panels are bad and he is not going to kill our grandmas. Who is this guy?

Osis on August 12, 2009 at 9:16 AM

wonder why these political masterminds didn’t try to pass parts of this socialist bill in pieces?

that’s how they’ve eroded our freedoms so far.

kelley in virginia on August 12, 2009 at 9:19 AM

Which is why I consider it malfeasance that the filthy liar in the White House and his party attempted to get this signed into law in three weeks.
highhopes on August 12, 2009 at 9:16 AM

Especially when Ogabe declared a few days ago that he wanted to get input from all sides and carefully deliberate everything before making a decision.

Bishop on August 12, 2009 at 9:20 AM

You know its bad when the president has to come out and say he believes death panels are bad and he is not going to kill our grandmas. Who is this guy?

Osis on August 12, 2009 at 9:16 AM

Killing grandmas = bad

Advocating killing a million unborn = O.K.

Got it Mr. President!

Rovin on August 12, 2009 at 9:20 AM

You know its bad when the president has to come out and say he believes death panels are bad and he is not going to kill our grandmas. Who is this guy?

Osis on August 12, 2009 at 9:16 AM

Obama’s words are misleading, obfuscating and irrelevant, the only words that matter are those within the legislation that will ultimately become the law. There is more than one way for the government to kill us. They can directly inject lethal poisons into our veins or smother us with a deadly toxic gas, or, they can refuse to give us the life saving medical care we may someday require. The government boards will have the power to refuse such care based on their opinion of our future worth to society and the cost-effectiveness of our survival. To designate them as “death boards” is perfectly appropriate. You may not like and it may make you squirm but it is true and accurate so stop waffling around the periphery and call it what it is. If you’re not scared to death, you should be.

rplat on August 12, 2009 at 9:23 AM

Especially when Ogabe declared a few days ago that he wanted to get input from all sides and carefully deliberate everything before making a decision.

Bishop on August 12, 2009 at 9:20 AM

This was truly a snortworthy lie by Obama. I really don’t think anyone — left, right, or center — believed him on that one.

jwolf on August 12, 2009 at 9:23 AM

It is absolutely infuriating watching the media (including some on Fox) question this legislative quagmire. Does no one know how to ask a follow-up question?

Carol in MD on August 12, 2009 at 9:25 AM

I worry about the plan B: the compromise – sponsored by Lindsey Graham and John McCain.

The devil is in the unwritten details that Selbilus has locked in her Obamacare trust fund vault.

Obama, cleverly, disassociates himself from congress’s plan so that he can claim he didn’t fail when it goes under.

Don L on August 12, 2009 at 9:26 AM

Your questions are a lot better than Coburn’s. His are all aimed at scoring political points rather than working out how the proposed bill will actually affect Americans directly. Typical Senator, all he can think about is the politics of it all.

AngusMc on August 12, 2009 at 9:27 AM

Just buried my mother this past week, and have been part of her health care decision team for the past many years.

I have also been there with other elderly relatives over the years,

Every physician I have dealt with when looking at the finals years of an elderly parent or family member while not telling said elderly patient “Gee, ain’t nothin’ I kin do for ya, here’s a couple capsules, take ‘em and you won’t feel a thing” in every case each physician has gone out of their way to explain the different options.

Heroic efforts, and why they may or may not work, and the relative pain involved and the ability of the patient to live a “normal” life in the final years.

Hospice care, in the few cases where this was indicated the physician not only offered to put the patient in contact with professional hospice providers, he also stated that he would be available at their call to see to their needs and explain to them anything that they did not understand from the hospice personnel.

Invasive surgery, the pros and cons, and prognosis for full or, most often, partial recovery.

Medication, always each time, the physicians involved went into the pros and cons of various medications that would ease suffering or pain and also which medications would have side-effects, as well as, in three cases in particular, point out the available services of a professional medical nutritionist to make sure diet did not interfere with the medications and even to the extent to point out that a proper diet, with some suggestions, would provide necessary nutirents and energy for the patient, and enhance the efficacy of the medications being prescribed.

In short, many many physicians take their role as a health care advisor and professional very seriously.

They have no mandate to do so, they are not following orders, nor some sort of directive from on high…they are simply offering patient care. Quality patient care.

In all cases there was pronounced fear in all the patients, save one, my mother, who expressed deep concerns and angst at what their final years would be like and how their diminished health would affect them…and the physicians involved in every case took the time to be solicitious, listened to their concerns and offered the best advice they could muster.

Again, most physicians do this routinely; each day, every day, moreso among those involved in geriatrics and oncology.

In the parts of the proposed legislation I have been able to obtain and read, and there are several versions being played with by Congress…not from the White House, I must add…there is an overwhelming tendency to not only paint with a broad brush, but also to use the one-size fits all rubric.

Knowing how government bureaucracy works…when it comes down to the case manager, or those making financial decisiopns as to actual costs for care, I strongly believe that there will be no deviation from the precise language of these bills, the so-called norm, should they become law, and broad brush one-size fits all decisions will be made, without recourse to appeal nor fashioning individual programs for individual patients in individual circumstances.

This Obamacare that Congress is toying with simply must be halted, now, before it imperils millions of Americans to benefit a very select few.

coldwarrior on August 12, 2009 at 9:28 AM

The government has already been trying to control costs for years its just not working. One of the biggest reasons is Doctors are forced to practice defensive medicine. You have a headache, well we better do an MRI of your brain just in case you might have a brain tumor. The biggest savings would be generated from tort reform. Obama was right, you have Fedex and Ups and then you have the post office, the picture of efficiency.

rbassett on August 12, 2009 at 9:33 AM

Obama, cleverly, disassociates himself from congress’s plan so that he can claim he didn’t fail when it goes under.

Don L on August 12, 2009 at 9:26 AM

That’s not the reason. Hillarycare failed because the White House tried to do all the writing and dealmaking themselves. It lead to illegal meetings and no stake in the outcome from Congress. The filthy liar’s team has spent hours upon hours making sure that Obamacare doesn’t hit the same traps that killed Hillarycare. They thought that by having Congress write the legislation they would be able to get a signed bill in a few weeks time.

No, the filthy liar in the White House is too involved to not have a political stake in the outcome. His out comes from “special interests” that beat back his efforts.

highhopes on August 12, 2009 at 9:42 AM

The government will have our health records and access to our bank accounts, what could go wrong.

Kissmygrits on August 12, 2009 at 9:50 AM

4) OTHER INFORMATION.—Such other information as the Secretary may require.

Actual “on the job” wording is .”and all other duties as prescribed by the manager” You sure can include a lot in so few words.

Jessie on August 12, 2009 at 10:02 AM

Great work, kbanian!

hawksruleva on August 12, 2009 at 10:10 AM

So, it’s OK if PRIVATE INDUSTRY kills you by denying you care because of a pre-existing condition… but it’s BAD if the GOVERNMENT regulates costs. Gotta love the logic!

Death by Free Market, A-OK!

bschmalfeldt on August 12, 2009 at 10:29 AM

The government already HAS access to your bank account. It’s called the IRS.

Bottom line… you don’t seem nearly as upset about insurance companies violating your rights as you are about the potential of government having access to some personal data…

Makes me wonder where all this concern over privacy was when many of the same folks were in her lauding Bush’s warantless wiretaps and e-mail browsing…

bschmalfeldt on August 12, 2009 at 10:31 AM

I know facts are important here… so let’s take care of this stuff about Obama being able to peer into your l’il bank account…

CNN offers this “Fact Check”

The Statement: Twice during a Pennsylvania town hall meeting with Sen. Arlen Specter on Tuesday, constituents urged him to fight a provision of pending health care legislation that one woman said “gives the government access to private individual bank accounts at their free will.”

“I do not think the government has the right to do that,” she said. “I would think I would have to brush up on my Constitution, but I would think that’s unconstitutional. I know definitely it’s un-American.”

The Facts: The woman cited section 163 of the more than 1,000-page bill now before the House of Representatives. The section, titled “Standards for financial and administrative transactions,” calls on the government to set “comprehensive, efficient and robust” rules for electronic transactions with as little need for paperwork as possible. It’s being painted by opponents as a measure that would give the government access to bank accounts and records, and it’s one of the items on a list of allegations about the bill that has been widely circulated online.

But the purpose of the measure is to set up a standardized payment system between insurers and doctors’ offices, according to the House Ways and Means Committee report on the bill. It would require procedures to “enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service,” and authorize electronic payments and require systems to be set up for “near real-time adjudication of claims,” the legislation states.

The Verdict: False. The provision cited doesn’t affect individuals, but companies involved in medical billing.

Now, let’s not let the fact that it isn’t TRUE stop us from wringing our hands about it, just like we’re all wringing our hands over the “death panels” that do not exist…

bschmalfeldt on August 12, 2009 at 10:41 AM

bschmalfeldt on August 12, 2009 at 10:29 AM

It is more fun when Dear Leader commands it, no?

daesleeper on August 12, 2009 at 10:49 AM

Makes me wonder where all this concern over privacy was when many of the same folks were in her lauding Bush’s warantless wiretaps and e-mail browsing…

bschmalfeldt on August 12, 2009 at 10:31 AM

Makes you wonder why Obama strengthened those wiretapping programs?

daesleeper on August 12, 2009 at 10:51 AM

I just can’t get by asking any other question than:

Would you please specify which article and section of the United States Constitution gives the Congress the right to forcibly interfere with my right to contract for my own health care and that of my family? Please cite the constitutional article.

To me, asking other questions ceeds that it is OK for the government to do this. Obviously it is not.

WashJeff on August 12, 2009 at 10:53 AM

daesleeper on August 12, 2009 at 10:51 AM

Face it, there are those who view free “anything” from government as their birthright. And there are those same people who are malevolently jealous of those who have accomplished great and not so great things in their lives by their own hard efforts.

I’m entering my sixth decade, and did not accomplish all those wonderful dreams of my youth, but, dammit, I still strive each day to make my life a bit better and for my kids, through my own efforts.

And I want no government taking that away from me…ever.

coldwarrior on August 12, 2009 at 10:59 AM

Troll alert!

Insurance not covering a treatment does not mean you cannot get that treatment. You can always pay out of pocket. You can always buy additional insurance. You can always switch providers. There are charity funds out there to help.

With Government Health Care you do not have a chance to get treatment if they do not let you have that treatment. There is an exclusivity clause, Government insurance is it. Once you are on Government insurance, you cannot go back, you cannot get out. It is like Organized Crime.

Moreover, this bill has no specific protections, no declaration of Patient Rights. Nowhere does it state you have a right to life saving treatment, no where does it state that a woman has a right to bring any pregnancy to term that she wants, no where does it state that Healthcare must be equal across the board.

This is not about healthcare. It is about Control.

Holger on August 12, 2009 at 11:00 AM

coldwarrior on August 12, 2009 at 10:59 AM

I’m with you 100% coldwarrior. The entitlement mentality and class envy is human nature. It is the basest mode of operation. The people that subscribe to that mentality think they are sophisticated or intelligent when in reality they are operating a modicum above animal instinct. It is sad really.

daesleeper on August 12, 2009 at 11:06 AM

And Death Panels will exist. It is in the damn bill! End of Life Counseling? How is that not a Government Death Panel?

Cost-Benefit Analysis of Patient Coverage? How is that not Death Panel.

This bill allows government to do what is not in its scope: determines who gets saved and who is left to die. How is this not a Death Panel?

Now where does this bill state what Government cannot do to you. No where does it state what Government must do for you.

Holger on August 12, 2009 at 11:08 AM

I’m wondering why Doctors would be explaining laws on health directives etc…Isn’t that practicing law without a license ?

Jeff2161 on August 12, 2009 at 11:11 AM

“So, it’s OK if PRIVATE INDUSTRY kills you by denying you care because of a pre-existing condition… but it’s BAD if the GOVERNMENT regulates costs. Gotta love the logic!”

There’s lots of choices in private industry – there’s only one government and they own the, laws, the judges, the guns.
My private insurance company isn’t forcing consultation about my end of life decisions with a government paid hack, who no doubt, will be reimbursed by the number of pills he disburses to someone’s timid guilt ridden granny.

Don L on August 12, 2009 at 11:14 AM

Do you have any evidence that this will save money? CBO says not before 2019.

That is a total money question. Now if any of the congressmen would actually organize a town hall here in MN besides Mr Muslim.

metric on August 12, 2009 at 11:16 AM

Question:

Recently, congress passed a bill, called T.A.R.P, to bail out the financial sector.

It wasn’t but a few days, congress had to play grab-ass and shuffle to undo the bill, because it was found, that it was paying the wages of Millionaires.

This was just one bill.

And now, you want to pass a bill, containing thousands of regulations, without any debate, and have us believe, every one of these regulations are perfect?

franksalterego on August 12, 2009 at 11:25 AM

Death by Free Market, A-OK!

bschmalfeldt on August 12, 2009 at 10:29 AM

In a competitive free market insurance companies that rip off their customers will not last long. People will move away from those companies towards ones that provide good service. Where do you go when your government is the one ripping you off?

PackerBronco on August 12, 2009 at 11:30 AM

metric on August 12, 2009 at 11:16 AM

Let’s say you start a self-owned small business and this year you lose $15k.

Next year, 2010, you lose $20k.

The next, 2011, you lose $25k

The next, 2012, you lose $30k.

The next, 2013, $35k

The next, 2014, $40k.

The next, 2015, you lose $45k.

The next, 2016, you lose $40

The next, 2017, you lose $35k

The next, 2018, you break even.

The next, 2019, you actually have $20k in the black for that year, for the first time.

How much have you saved? How much have you lost?

Only government would view the ten year succession of losses followed by one year of breaking even and one year of actually having a surplus as a positive model.

In business, you’d have closed shop around the third year or so, if that long.

And, with this Obamacare we still do not have reliable figures as to projected real costs. The CBO may be erring to the side of caution on their estimates. We really do not know. No one in DC knows either.

coldwarrior on August 12, 2009 at 11:30 AM

Let’s remember how the govt works. A law that creates a federal regulator is an enabling law. It has broad instructions to the new agency. That agency will write its own regulations. Congress doesn’t have to intervene and usually doesn’t.

If you don’t like the operation of the agency you must exhaust its internal selfmade rules on administrative relief before you can sue in federal court.

Remember the old IRS rule that you had to pay in full and then argue you hadn’t owed to begin with? That was lawful. It was a political decision to scrap it.

That’s apart from the fact that we won’t read a “final” version until the conference committee is done nipping and tucking and sending it to the President’s desk.

Any pol who says “euthanasia will not be allowed” without demanding explicit language to bar the Commission from creating regulations to impose cutoffs, is a despicable liar.

Chris_Balsz on August 12, 2009 at 11:39 AM

But the purpose of the measure is to set up a standardized payment system between insurers and doctors’ offices, according to the House Ways and Means Committee report on the bill. It would require procedures to “enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service,” and authorize electronic payments and require systems to be set up for “near real-time adjudication of claims,” the legislation states.

The Verdict: False. The provision cited doesn’t affect individuals, but companies involved in medical billing.

Now, let’s not let the fact that it isn’t TRUE stop us from wringing our hands about it, just like we’re all wringing our hands over the “death panels” that do not exist…

Pg 58 of the bill here makes it quite clear to all but liberal “factcheckers” that it indeed involves SOMEBODY doing a credit check on the PATIENT:

163 (2) (D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card; [emphasis added]

NOT whether an individual PHYSICIAN or the Company is liable.

Verdict: Socialist Propaganda.

Chris_Balsz on August 12, 2009 at 2:35 PM

Chris_Balsz on August 12, 2009 at 2:35 PM

Wasn’t all that long ago the usual suspects were aghast, up in arms, frothing at the mouth, over “data-mining” by government, even when it was directed to key word research directed against the very real threat of terrorism and jihad across the globe.

“Data-mining” back then(just a few years ago) was merely looking for sparkle in the pan.

This…the all encompassing swath under Obamacare is the Comstock Lode.

And to make things worse, provision of all sorts of personal information, to include financial, is required for access and services and enrollment….mandatory.

Anyone old enough to remember the various civil service employees who took it upon themselves to seek and publish information on Joe the Plumber, may wish to give this little provision buried deep deep within the bill(s) a serious second thought.

Kill Obamacare. It will be one huge Pandora’s Box we will never be able to close.

coldwarrior on August 12, 2009 at 3:23 PM