amonasro
08-12-2009, 10:27 AM
I read various chunks of HR 3200, America's Affordable Health Choices Act of 2009, last night at Opencongress.org (http://www.opencongress.org/bill/111-h3200/text).
As far as I can tell, it's full-on socialized medicine. It's seriously full speed ahead--get ready for it. It's a massive bill and quite complicated, and its implications will be far-reaching. The costs within it are staggering, and it gets more expensive as the years go on. Here are a few notes I made. All quotes are direct quotes from the bill.
Health Choices Administration. Creation of an independent government agency within the Executive branch, headed up by a Health Choices Commissioner, appointed by the President and approved by the Senate. He gets far-reaching powers to appoint, hire, regulate, allocate funding, create more bureaucracy... everything you might expect. [Sec. 141]
Within this bureaucracy sits the Health Benefits Advisory Committee, who "recommend covered benefits and essential, enhanced, and premium plans." Basically they set benefit standards. The Surgeon General sits at the helm, the Comptroller General appoints 9 members and the President appoints 17 members (!!!), 8 must be Federal employees. As far as I can see, they don't have to be doctors, but it is assumed they will be "health experts" in their respective fields. [Sec. 123]
Throughout, the bill, the term "acceptable health care" is used over and over. The Secretary of Health and Human Services (he gets greatly expanded powers) and his committees will decide what "acceptable health care" is. The bill is quite clear that if you don't have "acceptable health care", you'll be taxed 2.5% of your income. Nonresident aliens are exempt from this tax. [Sec. 59B] Businesses over a certain payroll will be taxed on an ascending scale if they don't provide healthcare, starting at 8% (there is a table but it's not clear) [Sec. 313]
Requirements in Reforming Health Insurance Marketplace. Private insurance companies are hit with heavy regulations. Basically, they have to provide what the Secretary defines as "acceptable health care" and there will be a grandfathering period where old plans will expire (or never change, not really clear). If an insurance company changes a plan in any way, it must comply with the new "acceptable health care" requirements. The Health Commissioner will enforce these standards. This section of the bill is difficult to understand. [Sec. 101]
An entire new core health infrastructure will be going into place via grants to individual states. What this infrastructure entails is decided by a "formula based on population size; burden of preventable disease and disability; and core public health infrastructure gaps..." also "The Secretary of Health will develop, and periodically review and update, standards for voluntary accreditation of State, local, or tribal health departments and public health laboratories for the purpose of advancing the quality and performance of such departments and laboratories" and "implement a program to accredit such health departments and laboratories in accordance with such standards." [Sec. 3161]
The Public Health Workforce Corps -- An entire new army of doctors will be trained via "approved university programs" through a loan repayment system, up to $35,000 per year ($50,000 in 2012). "The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop a methodology for placing and assigning Corps participants as public health professionals. Such methodology may allow for placing and assigning such participants in State, local, and tribal health departments and Federally qualified health centers." They get paid what the government deems necessary, and must work a set number of hours. [Sec. 2231]
A Health Insurance Exchange Trust Fund [Sec. 207] and Retiree Trust Fund and the Public Health Investment Fund [Sec. 2002] within the US Treasury will be created. Taxes, surcharges and penalties are paid into the Exchange Fund. "The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Insurance Exchange" This seems to be an a multi-billion dollar piggy bank run by the Treasury. The retiree fund is capped at $10 billion but the exchange fund doesn't seem to have a limit. :confused: The Public health Investment Fund, however, starts at $4.6 billion in 2010 and increases gradually to $12.7 billion in 2019.
The National Center for Health Statistics -- Possible computerized health records? I could only find this in a subsection regarding funding appropriations in Sec. 2002 B (viii).
Comparative Effectiveness Resarch -- another gov't deciding committee within another Federal Agency (the Agency for Healthcare Research and Quality) that will "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..." [Sec. 1401]
National Medical Device Registry -- This is scary. They will regulate and set standards for any device that has been used in or on a patient, and "any device that is implantable, life-supporting, or life-sustaining..." :eek: [Sec. 2521]
Health ID Cards -- That's right, here it comes... "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..." [Sec. 1173A]
Advance Care Planning Consultation -- An amendment to the Social Security Act to cover end-of-life services. "‘advance care planning consultation’ means a consultation between the individual and a practitioner... regarding advance care planning... if the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following... key questions and considerations, important steps, and suggested people to talk to... an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.... An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available..." [Sec. 1233]
Mental health, marital health [Sec. 1308] and nursing home regulations and workforce [Sec 1141 & 2221] and so much more. There's so much control over every aspect of medical care, it's quite astounding.
This is it people. If it passes, big changes for our country.
As far as I can tell, it's full-on socialized medicine. It's seriously full speed ahead--get ready for it. It's a massive bill and quite complicated, and its implications will be far-reaching. The costs within it are staggering, and it gets more expensive as the years go on. Here are a few notes I made. All quotes are direct quotes from the bill.
Health Choices Administration. Creation of an independent government agency within the Executive branch, headed up by a Health Choices Commissioner, appointed by the President and approved by the Senate. He gets far-reaching powers to appoint, hire, regulate, allocate funding, create more bureaucracy... everything you might expect. [Sec. 141]
Within this bureaucracy sits the Health Benefits Advisory Committee, who "recommend covered benefits and essential, enhanced, and premium plans." Basically they set benefit standards. The Surgeon General sits at the helm, the Comptroller General appoints 9 members and the President appoints 17 members (!!!), 8 must be Federal employees. As far as I can see, they don't have to be doctors, but it is assumed they will be "health experts" in their respective fields. [Sec. 123]
Throughout, the bill, the term "acceptable health care" is used over and over. The Secretary of Health and Human Services (he gets greatly expanded powers) and his committees will decide what "acceptable health care" is. The bill is quite clear that if you don't have "acceptable health care", you'll be taxed 2.5% of your income. Nonresident aliens are exempt from this tax. [Sec. 59B] Businesses over a certain payroll will be taxed on an ascending scale if they don't provide healthcare, starting at 8% (there is a table but it's not clear) [Sec. 313]
Requirements in Reforming Health Insurance Marketplace. Private insurance companies are hit with heavy regulations. Basically, they have to provide what the Secretary defines as "acceptable health care" and there will be a grandfathering period where old plans will expire (or never change, not really clear). If an insurance company changes a plan in any way, it must comply with the new "acceptable health care" requirements. The Health Commissioner will enforce these standards. This section of the bill is difficult to understand. [Sec. 101]
An entire new core health infrastructure will be going into place via grants to individual states. What this infrastructure entails is decided by a "formula based on population size; burden of preventable disease and disability; and core public health infrastructure gaps..." also "The Secretary of Health will develop, and periodically review and update, standards for voluntary accreditation of State, local, or tribal health departments and public health laboratories for the purpose of advancing the quality and performance of such departments and laboratories" and "implement a program to accredit such health departments and laboratories in accordance with such standards." [Sec. 3161]
The Public Health Workforce Corps -- An entire new army of doctors will be trained via "approved university programs" through a loan repayment system, up to $35,000 per year ($50,000 in 2012). "The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop a methodology for placing and assigning Corps participants as public health professionals. Such methodology may allow for placing and assigning such participants in State, local, and tribal health departments and Federally qualified health centers." They get paid what the government deems necessary, and must work a set number of hours. [Sec. 2231]
A Health Insurance Exchange Trust Fund [Sec. 207] and Retiree Trust Fund and the Public Health Investment Fund [Sec. 2002] within the US Treasury will be created. Taxes, surcharges and penalties are paid into the Exchange Fund. "The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Insurance Exchange" This seems to be an a multi-billion dollar piggy bank run by the Treasury. The retiree fund is capped at $10 billion but the exchange fund doesn't seem to have a limit. :confused: The Public health Investment Fund, however, starts at $4.6 billion in 2010 and increases gradually to $12.7 billion in 2019.
The National Center for Health Statistics -- Possible computerized health records? I could only find this in a subsection regarding funding appropriations in Sec. 2002 B (viii).
Comparative Effectiveness Resarch -- another gov't deciding committee within another Federal Agency (the Agency for Healthcare Research and Quality) that will "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..." [Sec. 1401]
National Medical Device Registry -- This is scary. They will regulate and set standards for any device that has been used in or on a patient, and "any device that is implantable, life-supporting, or life-sustaining..." :eek: [Sec. 2521]
Health ID Cards -- That's right, here it comes... "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..." [Sec. 1173A]
Advance Care Planning Consultation -- An amendment to the Social Security Act to cover end-of-life services. "‘advance care planning consultation’ means a consultation between the individual and a practitioner... regarding advance care planning... if the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following... key questions and considerations, important steps, and suggested people to talk to... an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.... An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available..." [Sec. 1233]
Mental health, marital health [Sec. 1308] and nursing home regulations and workforce [Sec 1141 & 2221] and so much more. There's so much control over every aspect of medical care, it's quite astounding.
This is it people. If it passes, big changes for our country.