A blog about living in Aberdeen, New Jersey.

Saturday, August 22, 2009

Health Care Reform Bill at Open Congress

Open Congress has the full text of America's Affordable Health Choices Act of 2009 (HR 3200) in case you want to actually read some or all of the House bill. People are leaving their comments on each section and subsection; you just click on Comments and you can read what people (and interest groups posing as users) are saying about what you are reading. The number of comments is indicated for each highlighted section.

For example, there are fifteen comments about Subtitle C Section 116 (a), which talks about keeping premiums low and preserving value for customers through the use of a medical loss ratio threshold that would compel insurers to provide rebates to customers if the ratios were exceeded. The comments were broadly negative, suggesting that the government ought not to discourage insurers from making a profit. There were several references to the government going socialist and/or being anti-business.

Keep in mind that lobbyists enter such online discussions to press their agendas. Not that all or even most of the comments fall into that category. But, then again, think about how many of you have posted comments to that site in the last week or so.

You can find out how to use the site here. They ask you to register if you want to leave comments. I wrote them with a suggestion that Open Congress provide links to portions of a bill, not just the main page of the bill. That would facilitate discussions in blogs. For example, I can direct you not only to Wikipedia's US Capitol article, but to its History section or its History subsection discussing the US Capitol during the War of 1812. At Open Congress, I don't seem to have that much flexibility. If I'm mistaken, let me know.

As for health care reform, I'm interested in getting non-emergency clients, usually the poor, out of emergency rooms. I'd like to be able to see a doctor when I've got a winter cold or flu instead of talking to his receptionist and getting an rx called into the pharmacy. I'd like my medical care tracked better by computer so I don't have to keep providing the same information over and over again when I seek medical care. And I'd like for everyone to be able to switch jobs and not worry about losing their health care.

I recognize that people are scared that the government is going to do something that will diminish their current level of care. Nothing has changed in the polls that show the population mistrustful of Congress, so why does President Obama leave Nancy Pelosi with so much discretion on major bills? I see her as Inside the Beltway business as usual. I voted for change, but not for that change to include passing the reins of power to an unpopular Congress.


  1. Pat,

    Are there any portions of the proposed legislation that you strongly support? If the objectives are to reduce costs and expand coverage, this is a terrible bill.

  2. The CBO estimates that by 2019 2/3rds of nonelderly uninsureds would be covered under this Act. Eligibility for Medicaid would be broadened. The uninsured and companies that don't provide coverage would have to pay fines. There would be both private and public options. I don't quite understand why the coverage provisions have such a dramatic effect on the deficit in 2014, but revenues offset many of the costs. It is going to cost something to insure so many people, many of whom don't have two nickels to rub together. A humanitarian effort is going on here, right? We just spent billions and billions of dollars fighting a war in Iraq that didn't need to be fought. I have absolutely no problem committing $200 billion to make sure everyone in the US has health care. What's not to like about that?

  3. Well, a couple of things.

    Let's assume for the moment that the government wasn't trying to nationalize healthcare and that its only goal was universal coverage.

    Some of your numbers need clarification.

    According to the CBO, by the time we cover 2/3rds of the currently uninsured, we'll have already spent $1,000,000,000.

    Also, government forecasts of program costs are notoriously low because they never calculate the program's effect on consumer behavior. The CBO's estimate assumes that people will consume the same amount of healthcare whether it's expensive or free. For examples of gross underestimates, you can look at Medicare, Tennessee, Massachusetts, and Maine.

    As for the 2014 dropoff, that's because the government will raise taxes in 2010 but the program doesn't take full effect until 2014. Those bonus years of tax revenue are used to hide the true cost since the CBO only uses a 10-year window.

    Add universal healthcare to medicare, medicaid, and social security, and the country will go bankrupt.

    That doesn't mean there are no alternatives to increasing coverage. Here are several ideas -
    1) Make healthcare more affordable - de-link a person's coverage to his employer, allow people to buy coverage across state lines, and allow insurance companies to offer catastrophic-only coverage. The marketplace will reduce costs and lower costs will generate more coverage.

    2) Provide a tax credit to low-income households towards the purchase of private insurance.

    3) Increase the availability of Wal Mart style clinics that allow nurses to provide basic care, such as dressing small wounds, administering vaccines, and performing routine physical examinations.

    4) We can further reduce the costs of healthcare by limiting malpractice liability, reducing the costs of drug development, and dramatically increasing the number of work visas for healthcare professionals.

    Universal coverage is a commendable goal. That doesn't make the government proposal a good idea.

  4. We are already paying for the uninsured to get medical care. It takes the form of higher hospital bills and higher insurance rates. The only difference is that we pay a huge price when the uninsured use the ER for treatment that would be much cheaper and more efficiently administered under a health insurance plan. We might even get a co-payment -- imagine that? Do you really think this trillion dollars represents some sort of new costs? We're already spending more than that out of pocket. The Act just consolidates those costs in one place and you're getting sticker shock. That trillion dollar number is a gross figure. It is reduced by revenues and cost savings. You can't simply establish more clinics. There has to be a comprehensive solution. The AMA supports this plan. So does AARP.

  5. The CBO letter states the current proposal "would result in a net increase in federal budget deficits of $1,042 billion over the 2010–2019 period." And that's assuming the new program doesn't change consumer behavior or provide additional coverage for illegal aliens.

    During that same time period, the states will only save about $10 billion.

    So, given the government's history of underestimating expenses, what's the evidence that consumers will enjoy significant cost savings without loss of quality care to offset the hundreds of billions of dollars in new annual spending?

  6. By the way, which clause of the constitution authorizes the federal government to provide a public option?

  7. The preamble calls for the promotion of the general welfare. The commerce clause allows the government to regulate things like health care and insurance. Net changes in the deficit are $239 billion. The figure you are citing is the gross estimate. Changes in outlays will be -$219 billion and changes in revenues will be +$583 billion, so your trillion dollar figure is winnowed down to my $239 billion. We can ignore the CBO as unreliable, but then we have no figures to discuss at all. As far as estimating is concerned, private enterprise has no corner on the market when it comes to accurate forecasting. Look at where GM is at the moment. How many accountants do you suppose they employ? I'm sure there are plenty of former GM employees looking for a government option health plan right now, something to save them from the thousands of dollars per month they have to spend to avoid catastrophe. All because the GM accountants couldn't calculate themselves out of a paper bag.

  8. The tenth amendment reads -
    "The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people. "

    The preamble is not a power delegated to the United States. The commerce clause allows the federal government to regulate interstate commerce, not set up its own company to compete with private businesses.

    Also, the quote from the CBO says "net increase in federal budget deficits". That's net, not gross. By 2019, our NET annual deficit will have increased over $200 billion assuming no change in consumer behavior.

    To be clear, we're talking about two different things. I'm talking about how much more money we're going to be spending. You're talking about how we're going to pay for it.

    According to the CBO, we'll be spending over a trillion dollars more during the next decade. To cover that, the bill calls for over $700 billion in new taxes and for cutting doctor reimbursements by over $100 billion.

    You can see a breakdown in the New England Journal of Medicine.

    To claim the bill will only increase the deficit (i.e. cost) $239 billion because we're going to raise taxes and cut fees to doctors is a bit misleading.

  9. It's misleading to suggest the act will raise the deficit a trillion dollars. No one speaks of gross costs. Everyone who refers to how much something will cost is looking at the net cost. The federal government has the right to get involved in health insurance, the same as it had the right to offer Social Security and Medicare. I see issues could result with competition between private and public companies, but I don't see a constitutional issue.

  10. You may recall the Supreme Court opposed Social Security on constitutional grounds until FDR threatened to pack the court. "A stitch in time saves nine."

  11. FDR really challenged those old judges when he said, " A lower mental or physical vigor leads men to avoid an examination of complicated and changed conditions. Little by little, new facts become blurred through old glasses fitted, as it were, for the needs of another generation; older men, assuming that the scene is the same as it was in the past, cease to explore or inquire into the present or the future."