communication / decision making

The Death of Our Politicians

As I read through discussions on HR 3200 (the Health Care Bill), specifics fall off precipitously after about page 500. At first, I thought that was because most people stopped reading by then. No insult intended: Reading–and deciphering–500 pages of this gibberish gives me a brain pain.

But, I was wrong. The reason is because the next 500 pages rehash the first 500 and then apply layers of bureaucracy, technicalities, and vault-loads of money. Therefore, if I reject the premise of the first half, no need to nitpick the rest.

Having said that, I’m going to anyway, but as general thoughts. This Bill has become like a bad neighborhood I don’t want to spend much more time in:

  • It allocates more funding for the health care bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181). Is that what we as Americans want?
  • It calls for too many future studies that should have been performed before writing the bill.
  • The Health Insurance Exchange is a new bureaucracy under a new Commissioner, but Public Health Insurance bypasses this and operates in an unspecified bureaucracy under the Department Secretary.
  • The Healthcare Smartcard permits individuals only “specific services by specific providers in specific facilities”
  • Only if physicians agree to remain Medicare providers will they be eligible for higher payments for any patients they see in the public health insurance option plan. (Sec 223).
  • People who do not have “acceptable coverage” (per government definition) must pay 2.5% of their income to the government …unless they are a nonresident alien or can prove a religious exemption. (Sec. 401)
  • Providers will be reimbursed for counseling on end-of-life decisions. HR 3200 includes suggestions for advanced directive orders, including specifics regarding intensity of medical intervention if the patient is pulseless, apneic, or has “serious cardiac or pulmonary problems.” (Sec. 1233)
  • A Center for Comparative Effectiveness Research (CER) will be established to use private medical records without patient or physician consent to conduct patient and physician surveillance and research “with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures….” (Sec 1401)
  • The Center for CER may secure private and other data on individuals “from any department or agency of the United States.” (Sec. 1401)
  • To hunt for “fraud, waste and abuse”, medical records can be available to the Attorney General. (Sec 1651)
  • Tenth Amendment Violation – Overreach of limits on federal powers: “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.” (U.S. Constitution)

Here are a few new words you’ll have to learn. They’re introduced in HR 3200:

  • credit eligible individual
  • Exchange-eligible
  • Healthcare Smartcard
  • Health insurance exchange
  • Individual Affordability Credits
  • Meaningful User
  • National Institute of Comparative Effectiveness–one of 53 new committees and departments
  • QHBP
  • Special Situation Authority

Argh… It appears our Congressional representatives have words while we as simple Americans have language. Only one communicates.


2 thoughts on “The Death of Our Politicians

  1. Man do I agree, I gotta take a respit reading this thing. I’m glad you mentioned a few things I hadn’t gotten to yet–one being the end of life discussions. This is possibly an examble of a non-issue being blown up while more important issues are left on the side lines. For years we’ve been discussing end of life issues with patients newly admitted to the hospital and we get paid of it (using prolonged service E&M code along with our standard service billing code). The only thing new here is additional incentive directed at my peers, many of which dog the issue because it is so time consuming. I like end of life stuff, and usually patients (not families) are pretty receptive.


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