Thursday, September 10, 2009

The Debate in Healthcare Reform

President Ronald Reagan once said “The most terrifying words in the English language are: I'm from the government and I'm here to help.” Those words come to mind when I think about the proposed healthcare reform bill, HR 3200.

Last night, President Obama once again delivered a beautifully crafted speech but much of what he said, to be generous, I believe is improbable. I’ve detailed my concerns and I’d be happy if someone could allay my fears.

Nationalization of Healthcare
Last night, President Obama proclaimed that the public option would simply be one option among many in a healthcare exchange; that only 5% of the public was expected to enroll. Furthermore, the public option would be subject to the same rules as all Qualified Health Benefits Plans (QHBP) and would have to be self-financed, following an initial startup fund of $2 billion. SEC. 222. PREMIUMS AND FINANCING (1B) requires premiums be set “at a level sufficient to fully finance the costs of” benefits plans and administrative overhead.

Weren’t social security, Freddie Mac, Fannie Mae, Amtrak, and the post office supposed to be self-sufficient? Are politicians really going to allow the government to charge market rates for healthcare? Is there any government sponsored organization that serves a large portion of the public and doesn’t receive subsidies, direct or indirect (i.e. loan guarantees)?

Will it be a true level playing field? The government can dictate reimbursement rates that the private market cannot. The public option has no enforcement mechanism to meet private industry’s accounting standards and obligations. The public option can afford to run at a loss. A private company cannot.

President Obama has admitted he is a “proponent of single-payer universal healthcare coverage,” i.e. nationalization. Won’t he and his congressional allies be sorely tempted to advance the public option by gaming the system? Personally, I would not invest in a health insurance company competing directly against the government.

National Debt
According to the non-partisan Congressional Budget Office, the costs of the proposed legislation will escalate to $200 billion per year by 2019 or about $1,300 per worker plus interest. That’s on top of a projected $9 trillion deficit, or about $60,000 per worker. And that’s assuming that illegal aliens won’t be covered, that the public option plan won’t operate at a debt, and that cutting a consumer’s cost for healthcare won’t increase his demand. How are we going to pay for everything?

These projections are also assuming that we only insure two-thirds of the uninsured. Insuring the last third, another 17 million people, could easily add another $100 billion a year to the deficit.

Quality of Care
President Obama insists that the proposal won’t ration or diminish the level of care we receive. Yet, he projects that by 2019, we’ll save $88 billion a year in Medicare and Medicaid through future “efficiencies”. Given the government’s track record, what if those savings don’t materialize? What if costs are above projections? How are we going to restrain costs without reducing care? Can we take money away from doctors, hospitals, and pharmaceutical companies without diminishing care?

Keeping My Insurance
President Obama claims that I can keep my current plan. I get my insurance through my spouse’s employer. Under HR 3200, that plan would have to be a Qualified Health Benefits Plan (QHBP) whose standards would be set by a Health Choices Commissioner.

My fear is that, in time, those standards would become too burdensome for my wife’s employer and it would stop providing coverage. Even if our coverage plan did qualify, her employer would have a powerful financial incentive to drop us.

Under the current proposal, my wife’s employer could either cover her healthcare or pay 8% of payroll. (SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE) 8% of payroll is far less than what her company is currently paying and it would be hard to justify to Wall St. paying millions for healthcare if the employees had an affordable alternative.

President Obama claimed the bill would not cover illegal aliens. He was referring to SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS, which states “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

The section is specifically referencing Subtitle C—Individual Affordability Credits. That means illegal aliens would NOT be able to get subsidies, but they WOULD be able to purchase the public option. Since pre-conditions would not be a barrier, it would be a mighty incentive for the ill to seek treatment in the United States.

Notice the clause references “lawfully present” rather than the customary term “U.S. citizens or permanent residents”. Those who are here lawfully, such as students or people on work visas, would be entitled to subsidized care. Unfortunately, the bill does not provide any enforcement mechanism to distinguish between those who are here legally and those who are not. The IRS provides Taxpayer Identification Numbers to aliens both legal and illegal. Since the government will need to use taxpayer ID numbers for aliens “lawfully present”, I’m afraid the government won’t distinguish between those who are present lawfully and unlawfully.

Another concern is that President Obama supports “a system that allows undocumented immigrants who are in good standing to pay a fine, learn English, and go to the back of the line for the opportunity to become citizens.” In other words, he supports changing an illegal alien’s status to “lawfully present”, which would trigger the subsidies.

Another possibility is the courts could simply nullify the clause. If the government can find one federal judge to rule that healthcare is a “right”, then the government could choose to abide by the ruling, not appeal, and provide subsidies to illegal aliens. In Pyler V. Doe, the Supreme Court ruled that the Fourteenth Amendment requires schools to provide the same services to illegal aliens. Surely, there’s one federal judge who would use that as a basis to expand healthcare coverage.

Lastly, nobody is suggesting that illegal aliens would be barred from purchasing the public option. If the public option operates at a deficit (which I believe it will), then that’s a de facto subsidy.

If the illegal aliens presently in the country are covered, now or in the future, cost projections would explode.

During the presidential campaign, government workers illegally released damaging information on Joe the Plumber to discredit a private citizen who had unwittingly entered the political arena. SEC. 241. AVAILABILITY THROUGH HEALTH INSURANCE EXCHANGE.- (d) ACCESS TO DATA – allows the Health Choices Commissioner to access your tax records if you seek “affordable credits”. Why expand access to tax records rather than have the treasury department make the determination?

The president declared that the program would not fund abortions. Actually, the bill does not proscribe funding abortions but does require the public option to conform with “individual rights and remedies under State laws”. (SEC. 151. RELATION TO OTHER REQUIREMENTS. (b) COVERAGE OFFERED THROUGH EXCHANGE) So, yes, there will likely be government-funded abortions. Personally, I don’t consider abortion equal to murder but I’m sure that those who do would not want their taxes to cover the procedure.

Other Options
It’s also troubling that a host of simpler, less costly, and less intrusive options are not being considered. Selling insurance across state lines, tort reform, catastrophic-only plans, expanding health savings accounts, and healthcare tax credits for the needy are off the table. Why?

Tennessee tried universal coverage and failed. Massachusetts tried universal coverage and failed. Yet, President Obama says this is change we can believe in. In ancient times, the Romans would test their bridges by forcing the master builders to stand under them while large loads crossed overhead. When our government reaches that level of accountability, I’ll believe. Till then, I’ll heed President Reagan’s warning. I support reforming healthcare but I do not support this bill.
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NsectionJoe said...

The other day I saw a bumper sticker on the back of a car on the Garden State Parkway. The bumper sticker in a mere few words encapsulated the most honest statement I think I may have ever read in my life. It read:

"Love your country but never trust your government"

I look at the history of our country's leadership as to its ability to properly govern, fund, monitor, protect and control such a vast undertaking of the suggested reforming of health care.

Historically our country's leadership has failed us time and time again monetarily, legally, socially, environmentally and far more.We live as the examples on a daily basis. It is the best form of government we have and that an entire country with hundreds of millions of people is hard to control, operate, fund and more.

Our new president gave a speech last night and has been pushing his healthcare agenda since they tried to push it through very quickly, almost unnoticed in late summer. Sadly many of our elected leadership were willing to vote on the vast reforming of healthcare as proposed without even reading or fully understanding it. It is over 1800 pages as it stands now and they were only given two weeks to read, study, question and all were almost expected to vote immediately. That true fact is just another example as to that which exemplifies the biggest part of the problem with our governmental leadership. They do not understand much of what they do.

Throwing money at societal problems as of late is no different solution to our government or its citizen's burden. It is just in massively larger numbers that they have thrown money at us. The national debt clock in New York City will have to add three more locations for numbers over what our government spent since January 22, 2009.

Sadly the late Sen. Ted Kennedy has now been placed into the public domain as some healthcare reform martyr, and Kennedy is little more then a prop for those seeking to push healthcare reform through too quickly. Sure Kennedy would have voted for it but ask him how to fund, control and monitor and you would have heard silence. Kennedy and his family were great ones for helping society, but we were the ones who were asked time and time again to fund all of their societal gifts.

We have a large percentage of our society used to be a glutenous society that wants to be taken care of from birth to death by its government? The middle class has reached the brink of collapse as the major funding source for every social program that has facilitated the cradle to grave mentality, that pervades our society and its leadership.

We cannot be the society that is based on the writings on the tablet held by the lady in the harbor. We can no longer afford to "Give us your tired, your poor your huddled masses yearning to be free". The middle class is now the huddled masses yearning to be free from a society that keeps us down by forcing us to pay far more then our fair share.

I am not some crazy anti-governmental wacko. I am a man tired of political leadership spending far too much time running for office rather then working in their offices. The oath these people take to serve does not mention self-service. The governmental machine is turning into a grinder and we, the middle class are the grindings.

In closing I ask all of you to ask yourself one question. Why do the vast majority of former politicians become lobbyists, employees or directors of healthcare companies upon retirement from what was supposed to be service to the public?

Our governmental leadership has engineered its own healthcare insurance, retirement and far more that we will never know about. They will not be a part of the reforming of health care that they will create for all of us you can be sure. They do not wait hours on end in stacked waiting rooms, they do not have to deal with improper billing, and far more like the rest of us do. They have taken care of themselves from the minute they are sworn in and past their deaths. It is not cradle to grave but it is all at our expense.

Anonymous said...

It may be rare,

Mr N section,

on this, We AGREE

on a side note: It is funny to hear the DEMS cry about the Repub. making noises during the speech (not counting the outburst). Today, 770 AM replayed the joint session in 2005, when the DEMS BOOED Bush. BOOED him. And now this is an outrage when the Repubs show their disdain to Obama double talk or "clarification"? What a joke!!!

Mim Song said...

"I support reforming healthcare but I do not support this bill." And that's why we elected you ... to the school board. Seriously, I haven't heard so much speculation and misinterpretation since I stood online for Pallone's town hall. You basically got everything either wrong or guessed at bad faith in the future. I started out with a high opinion of you; you've now dropped a few more points.

I know you'd like to see a point-by-point refutation of your arguments, but refutation -- based on fact, not myth, fear, and speculation -- is available in so many other places it'd be a waste of time to post it here.

I am as skeptical as anyone about our elected officials. I would never trust them beyond my ability to examine what they do and get rid of them if they abuse the power we loan to them. I understand that we have no such right of examination or recall over large and concentrated industries like insurance. Anyone who thinks they do not combine against the public interest is dreaming a dream of a capitalism that never was and never will be. They ration, collude, deceive, and waste billions.

Anyone who's ever worked for a large corporation, or any large entity, knows that you cannot trust any of them -- public or private sector. The lure of power and profit is too great. Our system is supposed to use opposing size to achieve balance. Right now the health industry, and corporations in general, are way too powerful; restoring government oversight is what's called for. I'm glad you're where you are, and Pallone is where he is.

CountyRdAgainstKauffand Greed said...

Cong. Pallone is an idiot. Here is one example as to why. He cries about Fort Monmouth closing and losing all those jobs. He says nothing about the Sandy Hook leases and their repeated extensions with no funding or solid plans. Just look at his voting record and you will realize why all of the state politicians failed on numerous occasions to vote in the positive for military appropriations. Now they think the fort closing has somebody else at fault. Deny, deny, deny is so true about our states leadership and most every politician. Aberdeen is no different.


Big Joe great input on this subject. You can be sure the people you work for will not like it though. That is why I read everything you post. You put yourself out there for all to see. If they ever come after you for speaking your mind they better be ready for what comes after. I still miss your letters in the paper. Keep it up. California Danny says hello.

Anonymous said...

NsectionJoe...I'd like to buy you a beer. This is the few posts of yours that I agree with. Well said.

Fly the flag every day said...

Well said Njoe. I love my country and have not trusted those who lead it for far too long. I agree with your cradle to grave example as well as the congressional and senatorial pension and health care that they receive. 99% of Americans do not know about the special deals they have set up for themselves. It makes the term Golden Parachute is child's play compared to what our governmental leadership has awarded themselves. Why do you think they all retire millionaires. It is certainly not due to hard work and ethical behavior. They disgust me each and every one of them.

Anonymous said...

This post and the responses is why I only look at the Aberdeener for local issues.

Hold the Pickle said...

How many people who post on this site, including the Aberdeener, paid close attention to the financial mess that was created by the Bush Administration?

Why wasn't there a post on this site about how tax cuts, the Afghan and Iraq wars, and prescription coverage for seniors were not part of the budget?

Where were the tea parties when Bush was president? He spent and spent and spent and never considered how to pay for everything.

Too much of what happens today in this country is about one side winning and one side losing. Unfortunately, the people of this country fail to realize that no matter who wins, Republican or Democrat, the average citizen is usually the loser.

Aberdeener said...

As you know, the items you mention pre-date this blog. The only other time I wrote about a national topic was the economic crisis.

I believe now, as I believed then, that simple solutions are often the best and that we could have averted (or at least postponed) the housing crisis by simply giving the interest earned from first-home mortgages the same tax-free status as municipal bonds.