Thursday, August 20, 2009

Health Care reform - HR 3200 review, Part 4

We are gonna cover a lot of ground today. Yesterday, we ended around P. 620 of HR 3200, the leading health care reform bill, and we'll stop around P. 900 today. As is custom, here's the link to the bill in case you want to follow along - Notable sections for today include :
  • P. 621 line 20 thru 25 says the government will define and develop "quality measures" (QM) for healthcare. Hmmm, the Federal government and quality - isn't that a bit of an oxymoron ??
  • P. 622 line 2 thru 16 the government is gonna spend $2 Million per year from 2010-2014 that they transfer from other trust funds to pay for these QMs. These better be some dang good quality measures.
  • P. 623 line 23 thru P. 624 line 15 says the QMs will be designed to assess outcomes and functional status of patients. Plus, they will be designed to "assess health disparities including those associated with race, ethnicity, age, gender, place of residence, or language." I saw an e-mail where the writer claimed this was profiling and could lead to discrimination in healthcare. Sounds possible based upon the wording in the bill.
  • P. 630 line 9 thru P. 632 line 2 says that multi-stakeholder groups including unions and community organizations will be formed to develop these QMs (ACORN again ??). Plus, $1 Million is gonna be appropriated each year from 2010-2014 to pay for it.
  • P. 632 line 14 thru P .633 line says once these QMs are developed, the government can choose to implement any of them. Think about that for a minute in regards to what some of them may be. Spooky, huh ??
  • P. 635 thru P. 653 says ANY and ALL transactions between manufacturers and distributors of medical equipment, supplies, and medication to doctors, hospitals, pharmacies, and others MUST be disclosed to the Secretary of Health and Human Services. Per each transaction not disclosed the violator will be fined at least $1000 up to a maximum of $10,000. If they KNOWINGLY fail to disclose, the fines jump to a minimum of $10,000 up to a maximum of $100,000 per transaction. Bascially, they will have to tell the government EVERYTHING about anything they do. Ridiculous.
  • P. 660 thru P. 661 line 4 says that if a hospital has unfilled residency positions, they will lose 90% of them.
  • P. 667 line 6 thru line 16 says the residencies lost (above) will be given to other hospitals who "have in effect formal arrangements" (what does that mean exactly ??) with the Secretary of Health and Human Services to train in Federally qualified health centers, rural health clinics, other non-provider settings, and that emphasize outpatient services. Sounds like someone's paying off some political IOU's and "spreading the wealth."
  • P. 676 thru P. 686 line 5 outlines how the government will regulate EVERY aspect of residency programs.
  • P. 686 line 15 thru line 21 says the government will spend $100 Million per year starting in 2011 to fight waste, fraud, and abuse. Isn't this the same government that spent $19 Million on a website to track the stimulus funds ?? How about let's try this idea - the best way to not waste money is NOT TO SPEND IT IN THE FIRST PLACE !!
  • P. 697 line 22 thru P. 698 - I almost pulled my hair out when I read this. It shows how ludicrous this whole thing is. It says that service providers will be fined $50,000 each time they prescribe a drug or service for someone who is not eligible for Federal health care. Uhhh .... hello. I thought this was Universal Health Care which means that everybody is eligible and everyone has it. So, why would these fines even be necesary ?? Makes absolutely no sense.
  • P. 701 line 15 thru P. 704 line 16 says that if any part of your healthcare plan is NOT in the government exchange then you do NOT get benefits. That means that if you go to see your PCP when he's in the plan, he refers you to a specialist for a procedure, in the meantime the PCP drops out, then your on the hook for the entire cost of the procedure that the specialist did. Doesn't sound too good, does it ??
  • P. 705 thru P. 707 states if the government gets complaints on a healthcare provider or supplier, the government can do a background check and issue sanctions including dis-enrolling that entity from the program. Oh yeah, one other thing - no judicial review or appeal of the government's determination is allowed. Denies due process.
  • P. 717 lines 5 thru line 23 contains some GOOD NEWS. The maximum period for providers to file Medicare claims is reduced from 3 years to 1. Should be a big plus for patients as it will speed up their claims.
  • P. 719 line 11 thru P. 720 says that any doctor who orders durable medical equipment or home medical services must be enrolled in Medicare. No choice.
  • P. 722 line 17 thru P. 723 line 14 mandates that doctors MUST have face to face meeting with patient before prescribing home health services. What are you supposed to do if you're disabled, live alone, and don't have transportation ??
  • P. 724 lines 16 thru 24 gives government the right to apply face to face requirement to ANY other healthcare service. Could this include a prescription refill, too ?? How's that gonna keep cost down ??
  • P. 735 lines 16 thru P. 736 line 3 allows the Secretary of Health and Human Services to give the U.S. Attorney General access to ALL health data.
  • P. 757 lines 22 thru P. 762 states the Federal government will shift burden of payments to Disproportionate Share Hospitals (DSH) off to the states. DSH is a program where the Feds pay hospitals that care for a large number of indigent patients for those services. They will shift the burden as follows - $1.5 Trillion in 2017, $2.5 Trillion in 2018, and $6 Trillion in 2019. Many governors are opposed to the bill because their states don't have the funds available to pick up the tab.
  • P. 768 line 4 thru P. 769 line 5 discusses Nurse Home Visitation Services. Some have said this section subtlely allows for government funded abortions when it mentions "increasing birth intervals between pregnancies." No specific mention of abortion is mentioned but if you think about that phrase, it makes you wonder what it really means.
  • P. 773 line 4 thru line 17 mandates eligibility for Family Planning Services and says "medical assistance shall be limited to family planning services and supplies." Could this be about government funded abortions ?? Once again, no specific mention is made, but it leaves the door open. Plus, doesn't Planned Parenthood promote abortions under the guise of "family planning ??"
  • P. 789 lines 19 thru P. 795 says government will set and regulate drug prices allowing them to control which new innovative life-saving drugs make it into the market. There goes innovation. This could prevent cures and treatment for some of the worst diseases from ever being developed because drug companies will not be able to recoup their costs. Tragic.
  • P. 797 line 21 thru P. 801 line 3 says that the government will make payments for graduate medical education allowing them to control doctors education.
  • P. 820 thru P. 823 line 18 says that upon the request of the Commissioner of Social Security you must provide all your financial information to the government so they can determine if you are eligible for low-income subsidies if you are on Medicare. They can ask for the same information if you are receiving low-income subsidies and they suspect you are actually ineligible. This allows them to go on a fishing expedition in your financial information without any probable cause. Once again, violates due process. Plus, the argument could be made that it's illegal under the 4th Amendment prohibition on unreasonable searches and seizures.
  • P. 824 lines 15 thru P. 826 line 4 sets up Comparative Effectiveness Research Trust Fund. Guess where part of the money is coming from ?? It's gonna be transferred from the Medicare Part B funds and the Medicare Prescription Drug Account. Medicare is going broke, so why are they robbing it to set up another trust fund ??
  • P. 829 thru P. 833 imposes a fee on ALL private health insurance plans and self-insured plans to be paid by the insurer.
  • P. 835 lines 11 thru line 13 says that fee WILL be treated like a tax. Anyone wanna guess why ?? It's because that way they have greater enforcement powers for collection and prosecuting any insurer who doesn't pay up.
  • P. 838 thru P. 845 line 20 creates a Home Visitation Program for families with young children or who are expecting. Basically, the government will come into you home and teach you how to raise and care for your kids. It's the nanny-state on steroids.
  • P. 859 thru P. 861 line 19 establishes a Public Health Fund at a cost of nearly $89 Billion. It will start funding at $4.6 Billion in 2010 and increase every year until 2019 when $12.7 Billion will go into it. In just 9 years, the annual funding increases by over 275%. So much for cost containment. One other thing - guess where the money comes from ?? The $787 Billion American Recovery and Reinvestment Act of 2009 a.k.a. The Stimulus Package a.k.a The Pork-ilus Package. Yeah, that's right - it's all borrowed !!
  • P. 865 thru P. 894 line 6 creates the National Health Service which is a program where doctors perform mandatory service to pay off their student loans. Taxpayers are gonna pay out about $4 Billion for this program from 2010-2019. It will allow the government to take over the education of medical students, dentists, and dental hygienists. Nurses will be able to join, too, if they are willing to work at healthcare facilities with nurse shortages. There is also a provision to establish "nurse-managed health centers" because the government is anticipating "health professional shortage areas." Think about it - in the last 4 days, you've read about all the bureaucratic red tape - if you were a doctor or nurse, would you want to stay in this if it passes ??
Whew !! I'm beat. We've only got another 100 pages to go. Tomorrow ... it's done. There's not many highlights left. We'll hit those tomorrow, tie it all together, and I'll provide some more sources of info.
One other quick thing - I've mentioned ACORN's involvement several times. Sometime in the next couple of weeks, we'll look at them. If you're curious in the meantime, Google them. See what ya find.
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