Tuesday, August 11, 2009

Health Care Reform and Me - H.R. 676

I attended yesterday's meeting at the Loyola Park Fieldhouse on healthcare reform. It was a friendly crowd whose biggest issue was single-payer vs public option. After the usual chest thumping by Moore, Fagus and James we got down to the real issue.

Congressman Danny Davis (candidate for Cook County Board President -- I signed the petition to get his name on the ballot) politicked first before speaking the truth about the negotiating that is occurring around this issue in Congress, including discussions about the choices that will be made in provisioning health care. He specifically cited the example of who gets a heart transplant; a 95 year old or 25 year old? He would support single payer, but if that is not doable he supports a public option.

William McNary, President of USAction focused on the principles of Health Care For America Now, and sees the issue in terms of affordability, equity in health care outcomes, comprehensive benefits, and a public option. Single payer would be the ultimate outcome, but he doesn't believe that is going to happen this time.

Dr. Anne Scheetz of the Illinois Single Payer Coalition was unwavering in her insistence that single payer was the only way to go. Basically, Medicare on steroids since it would be expanded to the entire population with additional benefits.

Leslie Combs of Congresswoman's Schakowsky's office focused on the accomplishments of the Congresswoman with H.R. 3200 and announced there will be a Town Hall at Niles West H.S., 5701 Oakton St., Skokie, on August 31 at 6:30 PM.

For those of us who may wonder about the wisdom of publicly funded and administered health care, Representative Anthony Weiner (D-NY) offered the opponents on his committee an opportunity to vote to discontinue Medicare. You know how that one went.

After listening to an hour and a half of discussion I am certain that most of the people in the room want health care reform, and they want it paid for by the government, which means all of us when you get down to it. According to Dr. Scheetz the single payer plan would be funded via a progressive income tax, although when I pulled up the relevant section over at Thomas for H.R. 676, the single payer bill, I found this:


(a) In General- The USNHC Program is to be funded as provided in subsection (c)(1).

(b) USNHC Trust Fund- There shall be established a USNHC Trust Fund in which funds provided under this section are deposited and from which expenditures under this Act are made.

(c) Funding-

(1) IN GENERAL- There are appropriated to the USNHC Trust Fund amounts sufficient to carry out this Act from the following sources:

(A) Existing sources of Federal Government revenues for health care.

(B) Increasing personal income taxes on the top 5 percent income earners.

(C) Instituting a modest and progressive excise tax on payroll and self-employment income.

(D) Instituting a small tax on stock and bond transactions.

(2) SYSTEM SAVINGS AS A SOURCE OF FINANCING- Funding otherwise required for the Program is reduced as a result of--

(A) vastly reducing paperwork;

(B) requiring a rational bulk procurement of medications under section 205(a); and

(C) improved access to preventive health care.

(3) ADDITIONAL ANNUAL APPROPRIATIONS TO USNHC PROGRAM- Additional sums are authorized to be appropriated annually as needed to maintain maximum quality, efficiency, and access under the Program.


Notwithstanding any other provision of law, there are hereby transferred and appropriated to carry out this Act, amounts from the Treasury equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs, including funds that would have been appropriated under the Medicare program under title XVIII of the Social Security Act, under the Medicaid program under title XIX of such Act, and under the Children's Health Insurance Program under title XXI of such Act.

Ok, I don't know what existing revenue sources exist, other than those specifically mentioned in Sec. 212 above. I do know that instituting an additional tax on the top 5% of income earners (and there is a legal distinction between earned and unearned income) as well as an excise tax on payroll and self employment income (badly worded in my opinion) is hardly the progressive income tax that Dr. Scheetz suggested in which all of us help pay for it. In this case, the "all" is the fabuously wealthy, depending on what the cutoff turns out to be, the self employed, and businesses.

On top of that, "system savings" will magically finance the rest. A lot of numbers are being bandied about regarding the waste in the current system and the outrageous administrative costs that will magically go "Poof" when single payer is enacted, thus making it financially viable. We save money and everybody gets quality health care. Sounds like smoke and mirrors to me.

And just what are we paying for? Allow me to turn your attention to Sec. 201-206, all of which discuss budgets and reimbursements. In general, the budgeting process is pretty straightforward:


(a) Establishment of Operating Budget and Capital Expenditures Budget-

(1) IN GENERAL- To carry out this Act there are established on an annual basis consistent with this title--

(A) an operating budget, including amounts for optimal physician, nurse, and other health care professional staffing;

(B) a capital expenditures budget;

(C) reimbursement levels for providers consistent with subtitle B; and

(D) a health professional education budget, including amounts for the continued funding of resident physician training programs.

(2) REGIONAL ALLOCATION- After Congress appropriates amounts for the annual budget for the USNHC Program, the Director shall provide the regional offices with an annual funding allotment to cover the costs of each region's expenditures. Such allotment shall cover global budgets, reimbursements to clinicians, health professional education, and capital expenditures. Regional offices may receive additional funds from the national program at the discretion of the Director.

(b) Operating Budget- The operating budget shall be used for--

(1) payment for services rendered by physicians and other clinicians;

(2) global budgets for institutional providers;

(3) capitation payments for capitated groups; and

(4) administration of the Program.

(c) Capital Expenditures Budget- The capital expenditures budget shall be used for funds needed for--

(1) the construction or renovation of health facilities; and

(2) for major equipment purchases.

(d) Prohibition Against Co-Mingling Operations and Capital Improvement Funds- It is prohibited to use funds under this Act that are earmarked--

(1) for operations for capital expenditures; or

(2) for capital expenditures for operations.

The limitations on service to patients will be driven by the budget process, make no mistake about that. If health care is being rationed now because hospitals and providers are living on the edge due to funding constraints, there is no guarantee that it will get better under this bill. We have lots of priorities in this country, and Medicare is one of them. If funding becomes an issue, services will suffer or reimbursements will suffer, in which case services will still be reduced if they can't be properly paid for. Consider, for example, Sec. 203. Payment for Long Term Care(c):

(c) Basis for Budgets- Budgets for long-term care services under this section shall be based on past expenditures, financial and clinical performance, utilization, and projected changes in service, wages, and other related factors.

As recently as 2 years ago, Medicare's problems with rising costs were documented. The basic information about the FY 2009 Medicare budget identifies opportunities to save money, including reductions in payments to various entities. Medicare clearly has opportunities to restructure and save money. However, the issue for Medicare is overall rising health care costs, not revenue per se. The proponents for single payer, especially Dr. Scheetz' group ought to be able to document this in excruciating detail. For whatever reason, there isn't even a pie chart on the front page of their website detailing the savings that could be achieved if private insurance went "buh-bye" and Medicare became the single payer for all.

If Single Payer is not a panacea, is a Public Option any better?

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