More on Kennedy’s Health Bill
As it turns out, the bill is not actually Senator Kennedy’s – who is sidelined with critical illness and we wish him well. This bill was apparently drafted by the committee staff under the nominal leadership of Sen. Dodd. Both Keith Hennessey and the Republican Policy Committee have provided analyses.
- Everyone will be required to buy health insurance – either directly or through an employer.
- A federal health board will define “essential health benefits” that everyone must have and will undoubtedly make cost-effectiveness (rationing) decisions like similar boards in Britain and other countries.
- If you fail to purchase insurance, you will be taxed and the size of tax penalties will be determined by the Secretary of Health and Human Services and the Secretary of the Treasury. (A rather incredible delegation of power!) A similar “play-or-pay” tax will be imposed on employers.
- Outside the place of work, insurance will be purchased in a government-controlled exchange and the exchange must include at least one government-run health plan.
- The government health plan will pay Medicare rates plus 10%, which is bad news for seniors. More than 100 million people may move from private coverage to Medicare but since young people will be paying higher rates, seniors will be the least preferred patients (last to get access to doctors).
- Existing plans will be grandfathered, but all other plans must implement managed care type rules that interfere with the doctor-patient relationship (“case management,” “best clinical practices,” “evidence-based medicine,” etc.).
This isn’t socialism. It is facism.
Agree, Ken. I can hear the jackboots coming.
Husbands and wives must have different health insurance plans chosen by their employers or employers will be burdened with a tax.
I suppose the children go to SCHIP.
I think it’s fair to call this Socialized Medicine.
I almost laughed: To allegedly improve individuals’ choice of plans, the bill subsidizes “Gateways” operated by states, that will help you pick the best plan. However, in an admission that the Gateways will be government bureaucracies that will be too difficult for ordinary people to figure out on their own, the bill also offers subsidies for a new boondoggle called “Navigators”: agencies that will get a handout to help us understand what the heck is going on.
It’s kind of like the government giving H&R Block or TurboTax a handout to help me do my tax return, I guess!
Ron, why don’t we compromize and call it National Socialist Medicine.
I just stumbled upon this blog, and I was surprised by the ending comments in this entry. Specifically, do you believe that best clinical practices and evidence-based medicine interfere with the doctor-patient relationship? If they do interfere with that “relationship,” what is the particular benefit of a doctor-patient relationship that makes protecting it more important than following best practices and making care decisions guided by scientific evidence?
Perhaps you’re just using these phrases as scare words (complete with scary quotation marks) to imply an infringement of the doctor’s unchallengeable “best” judgment?
When used as a metric to measure physician performance, evidence-based medicine (EBM) requirements (or whatever they have been renamed this month) often interfere both with clinical judgment and patient relationships, especially if combined with pay-for-performance.
For example, some pediatric practices have refused to accept patients whose parents have religious objections to certain vaccines. Treating patients who refuse some vaccinations lowers the EBM metric of the percentage of patients vaccinated. There are papers in the literature suggesting that cardiac report cards in New York encourage physicians to refuse care to more seriously ill patients–they don’t want the increased mortality to ruin their record.
Finally, the recommended care that comes out of many of the big randomized studies is questionable. The JNC 7 studies that came out of the ALLHAT study, supposedly a triumph of EBM, would, if followed by doctors subject to best clinical practice guidelines rather than their best judgment, likely increase the kidney failure and mortality rate for Caucasians with high blood pressure.
Let’s take this one point at a time—
1)Everyone will be required to buy health insurance – either directly or through an employer.
reply- so what. we do that for othewr types of insurance now anyway. There is no difference here.
2)A federal health board will define “essential health benefits” that everyone must have and will undoubtedly make cost-effectiveness (rationing) decisions like similar boards in Britain and other countries.
reply- This already happens with today’s insuarance feilds. This a blatant scare-tactic and is always mis-represented by conservatives. Insurance companies alreday determine what you can and cannot have as far as medical treatment. Your doctor’s wishes and indeed your own wishes are not even in the equation.
4)
3)If you fail to purchase insurance, you will be taxed and the size of tax penalties will be determined by the Secretary of Health and Human Services and the Secretary of the Treasury. (A rather incredible delegation of power!) A similar “play-or-pay” tax will be imposed on employers
reply- Again this is already the case with other types of insurance which includes possible jail-time for infractions. This is not a new concept.
4)Outside the place of work, insurance will be purchased in a government-controlled exchange and the exchange must include at least one government-run health plan.
reply- Great, a one place stop to compare costs and features of different insurance plans. Also to have affordable options rather than the current situation where you have to figuratively sell at least one child into slavery to afford minimal protections.
5)The government health plan will pay Medicare rates plus 10%, which is bad news for seniors. More than 100 million people may move from private coverage to Medicare but since young people will be paying higher rates, seniors will be the least preferred patients (last to get access to doctors).
reply- Great- compared to most insurance plans out there, this pays MORE of a person’s medical bills. You are lucky if your insurance plan doesn’t drop you in the middle of a hospitalization and you still can expect to only have 50-60% coverage rather than the 80-90% covered costs. The elderly under this situation would actually be saving more money scince currently they are responsible for 20% of their bill and the medicare + 10% rule would make them now redsponsible for only 10% of the cost. MORE savings!!!!!! Only conservatives would try to make this into a bad thing.
6)Existing plans will be grandfathered, but all other plans must implement managed care type rules that interfere with the doctor-patient relationship (“case management,” “best clinical practices,” “evidence-based medicine,” etc.).
reply- Again insurance companies already interfere with the doctor/patient relationship. Insurance companies dictate health-care to your doctor. They already have the language listed—
“(“case management,” “best clinical practices,” “evidence-based medicine,” etc.).”
Why are people avoidiong, or even ignoring, what the reality is? Conservatives are bent on preserving the status quo. They do not want health-care to be available or affordable, as long as they get theirs paid for by the tax-payer, those same tax-payers can starve for all they care. The proof is in the pudding. If the consevative ideals and proposals for reform had any real positive results then it would be a different matter. The proof is that the same proposals, the dsame language and rhetoric has led to not more affordability but less, noyt more insured but less, not better quality but less. Trying to achieve different ends without changing the approach is mere stupidity. Conservative reforms are proven to NOT work and yet here we are still listening to the same exact “conservative answers” to this problem. I say exactly the same because scince the time of Reagan, nothing has changed in the approach of conservatives, not the language, not the lies and fear, and certainly not the results.
Brian: You need to spend more time at this site if you think I or the other posters here favor the status quo. We most certainly do not.
The following paprrgaah is taken from an IRS publication regarding Itemized Deductions.Medical expenses include insurance premiums paid for accident and health or qualified long-term care insurance. You may not deduct insurance premiums for life insurance, for policies providing for loss of wages because of illness or injury, or policies that pay you a guaranteed amount each week for a sickness. In addition, the deduction for a qualified long–term care insurance policy’s premium is limited. Refer to Publication 502 , Medical and Dental Expenses.