3. Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
Response: Pure sleight-of-hand here. Currently, you can appeal an insurance company’s decision but you can’t appeal the content of their policy. This Advisory Committee is the equivalent to the insurance company determining the content of the policy. Yes, there will be people very unhappy with the decisions it may reach, just as there are people very unhappy with such decisions by insurance companies under the current system. Also, nothing in this bill prevents an individual with money from paying for non-covered services, and nothing prevents an insurance company from exceeding the minimum requirements.
4. Page 42: The “Health Choices Commissioner” will decide health benefits for you. You will have no choice. None.
Response: The Commissioner is basically charged to ensure that, for example, insurance companies are not cheating their subscribers by offering plans that fail to meet reasonable minimum standards (such as excessive co-pays or deductibles so high that they discourage patients from seeking care). Again, there is nothing here that would stop an insurance company from exceeding the government’s minimum standards. It would likely become one of the main bases on which they would compete. Stopping insurance companies from engaging in harmful behaviors is, I think, a good thing.
5. Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
Response: Sorry, no such language in the bill. No such bill would stand a chance of passing Congress. If the writer is seeking to remind people that emergency rooms will have to treat all comers, that is already the case. Also, using fear of illegal immigrants to spread these falsehoods is, frankly, beyond despicable.
6. Page 58: Every person will be issued a National ID Healthcard.
Response: This claim is accurate. If the law is enacted, you would get a healthcare ID card. You now have a government-issued Social Security card and (if insured) a corporate-issued health insurance card. If you are over 65 or disabled, you now have a Medicare card. If you are a veteran, you have a VA health care card. If you are active duty military, you have a government-issued card for that. To the best of my knowledge, these cards do not possess laser-powered death rays. We all prefer to be seen as a person and not a number, but ID cards are part of modern society.
7. Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
Response: There are arrangements here for electronic funds transfer. If my employer deposits my paycheck directly into my account, I guess that in a sense, this gives my employer “real-time access to my individual bank account.” I see no intent or permission in the bill for anyone in government to go snooping around my bank account. Is it possible? In the electronic era, if someone (government, criminal, recreational hacker, whoever) is technically skilled enough, I suppose they could accomplish that. But that’s not what this bill is setting up.
8. Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
Response: This is where the people writing the email let you know that they hate unions, ACORN and community organizers (i.e., President Obama). This is based a temporary reinsurance program in the bill that applies to all employer-based health and retirement plans, union or non-union. Community organizers are not mentioned. The emailer could instead have noted that this part of the bill would cause taxpayers to subsidize police and fire fighters pension plans, or pension plans of corporate CEOs. It’s equally true. However, that wouldn’t as effectively meet his/her political goals, so they direct their hatred to those they deem most deserving of it.
9. Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
Response: Yes, this is an effort to prevent unscrupulous corporate insurers from failing to live up to minimum standards. It is also an effort to give all citizens eligible to purchase insurance from the Exchange the opportunity to choose from a series of health plans, rather than just having one or two to choose from.
10. Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans) .
Response: The Healthcare Exchange is a mechanism whereby health insurance consumers will be able to see a choice of clearly explained insurance plans to choose from. There will be a minimum benefits package that all plans must meet to be on the Exchange. Some will certainly exceed this minimum and use those add-ons to competitive advantage. As part of qualifying, these plans will, for example, have to stop denying coverage based on pre-existing conditions and there will be limits on the extent to which different people can be charged different prices based on, say, their age. Currently, insurance law operates largely on a state-by-state basis. State governments impose certain requirements. Based on the reasoning of the emailer, one could say that state governments currently exercise “total government control” over private insurance plans. The truth is that they regulate but do not totally control; the same will be true of the Exchange.
11. Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens.
Response: Here is the entire section that set off the emailer’s objection: “The entity shall provide for culturally and linguistically appropriate communication and health services.” Yes, that’s all. Again, the emailer is letting you know which groups he/she hates and wishes you to hate, in this case illegals (again). Bottom line: if a sick person (maybe it’s your neighbor’s elderly aunt or uncle) does not speak English well enough to understand all of what her/his doctor is saying, good health policy involves trying to find ways to allow that communication to occur with as little misunderstanding as possible.
12. Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
Response: This section relates to outreach to inform people about their available health coverage choices. The bill states, “Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.” Do you think this is a bad idea? Why? I would imagine that many individuals or groups might want to participate in this outreach. It might be a worthwhile project for a service club or PTA, for example. Again, ACORN and Americorps are not mentioned anywhere in the bill. But for the emailer, they are everywhere and the cause of his/her overwhelming fears.
13. Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
Response: If you are on Medicaid, this generally means that you are too poor to pay for private insurance. Medicaid is a government-funded insurance plan for poor people. This will give them coverage if they choose to do so. There’s nothing here that will force those insured under Medicaid to actually use the policy, i.e., go to the doctor. Again, what’s the problem? What is the emailer afraid of?
14. Page 124: No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly. Put simply, private insurers will be crushed.
Response: If anything, this bill bends over backwards to make sure that there is not a government monopoly. I read p. 124 and I don’t see anything about price-fixing or anything in this section or elsewhere in the bill that indicates a government monopoly. There is also no statement for or against judicial review that I can see. Of course, the Supreme Court and other federal courts would retain jurisdiction over the constitutionality of this federal law, as they do over all other federal laws. Nothing in this bill eliminates that. In this section, the HHS Secretary does have the power to make certain financial decisions, outlined in section 224 on the next page (125), as follows: “the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value based purchasing, bundling of services, differential payment rates, performance or utilization based payments, partial capitation, and direct contracting with providers.” Regarding the predicted “crushing” of private insurers, I expect that some private insurers may have difficulty; others will thrive, to the consternation of many who would actually favor a government monopoly. Again, there is no government monopoly created by any of the bills now being considered by Congress.
15. Page 127: The AMA sold doctors out: the government will set wages.
Response: The government will set reimbursement rates for the public option, as it does for Medicare, Medicaid, Federal Worker’s Compensation, as state governments do for state worker’s compensation, and as private insurance companies do for virtually every service they cover. This is a fact of modern life in America, throughout the private and public healthcare sectors. Regarding the AMA, they’re not suicidal. I assume that the organization looked at all the moving parts in this wide-ranging health care proposal, looked at the multiple unsustainable trend lines for the current system (i.e., what will happen if there is no reform), and decided that this was the best choice in a range of choices that all fall far short of the ideal.
16. Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
Response: That’s not what the bill says. There are numerous private options available. Unlike the current situation where employers will usually offer a single, take-it-or-leave-it option.
17. Page 146: Employers MUST pay healthcare bills for part-time employees AND their families.
Response: I’m not certain that the family coverage is a requirement as I read this section, but I would hope that it is. Having a policy that covers the employee but leaves out his/her spouse or child would be a step backwards. There’s language here saying that when employers cover part-time employees, they pay based proportionately on the number of hours the employee works per week. Also, small employers are exempted from the requirement to offer insurance. Employers who are not small enough to be exempted but who refuse to cover their employees will have to pay a penalty. One of the reasons for that is to keep employers who currently provide coverage to their employees from dropping that coverage. There is legitimate debate as to whether the penalties in the bill are high enough to accomplish that goal.
18. Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll.
Response: This is the penalty noted in the last response (146). Based on what the emailer said earlier, I should specify that it’s not solely the public option, but a wide range of options of which the public option is one.
19. Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll.
Response: See last response (149).
20. Page 167: Any individual who doesn’t have acceptable healthcare (according to the government) will be taxed 2.5% of income.
Response: Partially true. The House bill does contain an individual mandate. But the payment is capped at the amount of the “national average premium.” This section may or may not survive in a final, blended bill.
21. Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
Response: The implication of this claim is that Americans’ taxes will cover the health insurance costs of nonresident aliens who are exempted from paying these health care-related taxes. My take on the legislative language is that these aliens are neither covered nor taxed to pay for said coverage. If that’s accurate, it appears to be a wash, not a burden on U.S. taxpayers. Perhaps an attorney could clarify this.
22. Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
Response: Those Americans whose income is low enough to qualify for help in paying for their health insurance will need to prove that their income is, in fact, at the level needed to qualify. This is similar to various public assistance programs currently in existence. Subsidies should go to those who truly need them, not cheaters trying to save a buck. If you don’t have an income low enough to qualify for these subsidies, this section doesn’t apply to you.
23. Page 203: “The tax imposed under this section shall not be treated as tax.” Yes, it really says that.
Response: Yes, it really says that if you cut off the quote in mid-sentence. Here’s the full sentence: “The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.’’ My understanding is that tax law (whether written by Democrats, Republicans, or Whigs) is always complex and arcane. This fits well into that category. Perhaps the emailer is aware of something particularly sinister in this sentence. I don’t see it.
24. Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected.”
Response: This is definitely one of the places where the rubber hits the road. Context is everything, however. Please remember that Medicaid and Medicare have unsustainable economic trendlines already, health reform or no health reform. It’s a very, very large problem. This is one effort to deal with it. There do not appear to be any easy choices. Stopping health reform will not make things better; it will almost certainly make them worse.
25. Page 241: Doctors: no matter what specialty you have, you’ll all be paid the same (thanks, AMA!)
Response: More disinformation. In the actual bill (not the paranoid fantasy version presented by our intrepid emailer), there are certain evaluation and management codes and certain preventive services which will be reimbursed equally, whatever the physician’s specialty. From my point of view, that’s good, an example of a nondiscrimination clause among at least MD/DO providers. However, there is nothing here to force heart surgeons into the same income category as primary care physicians. It might be nice to see those extreme disparities closed up a bit, but this section doesn’t deal with that.
26. Page 253: Government sets value of doctors’ time, their professional judgment, etc.
Response: Someone is going to do it. The private sector still will hold some of this power. The government will hold some as well. The big question is whether you would rather have the insurance companies or representative government doing the job. Reasonable people can disagree about which is the right way to go. But reasonable people can’t act as though insurance companies aren’t doing this right now and still retain any credibility for their attacks on health reform.
27. Page 265: Government mandates and controls productivity for private healthcare industries.
Response: I have the impression that this claim is an inaccurate explanation of this section, but the legislative language here is dense enough, and refers to so many other sections of law, that I will withhold judgment. A health policy expert or attorney would be helpful in cutting through the linguistic weeds here.
28. Page 268: Government regulates rental and purchase of power-driven wheelchairs.
Response: This section consists solely of an update of the terminology used to describe new, higher-tech wheelchairs. No, the government is not going to take your grandmother’s power wheelchair away from her. In some cases, they’ll pay for it, as is the case now.
29. Page 272: Cancer patients: welcome to the wonderful world of rationing!
Response: If in your definition of rationing, you include all efforts to control costs, then there is a lot of rationing today and there will be a lot of it in the future. This section tells the Secretary of HHS to evaluate the costs at various cancer hospitals, determine if some are charging way above the average, and to adjust their reimbursements downward to reflect what’s being done in hospitals that are both effective and cost-effective. This sounds like reasonable policy when costs are skyrocketing at unsustainable rates, though it remains to be seen if it will be too weak to make a big difference.
30. Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
Response: Obviously, this would be a problem if every time a patient was readmitted to a hospital, payment was denied. Certain cases, of course, legitimately require readmission. But, as with virtually every other false claim in this endless list of false claims, that’s not what’s being proposed. This section (approximately pages 280-286) deals with patterns of excessive readmissions, and seeks to change the behavior of hospitals that are performing worse than the norm in terms of have having far more readmissions than other hospitals. This is sound public policy.
31. Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
Response: Similar to the last response (280), this seeks to measure readmission rates and to change the behavior of outliers, those who readmit too often compared to the expected or typical rate. This is an effort to improve substandard practices.
32. Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
Response: First, the bill’s language does not prohibit physicians from owning, say, a hospital. It goes into great detail on how to minimize conflicts of interest and various forms of insider dealing. Contrary to the emailer’s viewpoint, conflicts of interest resulting from self-referral arrangements are a longstanding problem in health care. For example, if a primary care physician refers a patient for an MRI, the patient trusts that it is because the MRI is needed, not because the physician owns the MRI facility and sends nearly all patients to that facility only. This is particularly egregious if it is a more expensive facility from which the referring doctor receives substantial income. Should government regulate this? I would say yes. Various attempts have been made over the years. This is another. Just as a judge should recuse himself or herself from cases where he/she has a conflict of interest or appearance of such a conflict, doctors should also be held to high ethical standards.
33. Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
Response: Unregulated expansion of for-profit hospitals is a signficant driver of health care inflation and resultant unsustainable health budget projections. This is an extremely urgent policy change. The more duplication of high-tech machinery and procedures there is in a given geographical area, the more these are used and the higher overall health expenses rise. This policy change is essential for getting medical inflation under control.
34. Page 321: Hospital expansion hinges on “community” input: in other words, yet another payoff for ACORN.
Response: This is one of the places where the emailer edges into full-blown paranoia. In what version of the English language does “community” equal “ACORN”? This is certifiable tinfoil hat territory.
35. Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
Response: This is quite something. Take a moment to think about it. The emailer is expressing outright opposition to “outcome-based measures,” that is, opposition to seeing what works most effectively and then incentivizing the use of more effective approaches. This killing of research-based policy-making is, in a nutshell, the number one priority of the drug companies and medical device manufacturers. They fear it more than anything else in the health reform bill. They do not want effectiveness or cost-effectiveness to be part of the equation, because it will cost them billions. Intentionally or not, this emailer is telling everyone to support a central component of the corporate agenda.
36. Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
Response: Yes, as is true of various state and federal policies, if an insurance plan is incompetent, fraudulent, fails to meet minimum standards, etc., the government can disqualify it. I believe that this is, to a large extent, codifying policy already in place.
37. Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
Response: This is not misinterpretation; it is a flat-out, baldfaced lie based on the assumption that you will never read the bill. The emailer is cynically playing you for a sucker. This section is about HHS doing a study of existing programs for special needs individuals and reporting to Congress about how to approach the issue of programs that have problems, that are not serving their clients’ needs well. It is the opposite of what the emailer is leading you to believe. It aims to help special needs individuals, not harm them. This is on my list of the two or three most dishonest claims in a long list of dishonest claims.
38. Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
Response: This is an effort to provide people in rural areas with better access to the best available care, much of which is centered in cities or academic medical centers. What is the emailer’s problem with encouraging that as a matter of nationwide public policy? Does he/she hate rural people?
39. Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
Response: I challenge anyone to read this section and tell me how it is endorsing assisted suicide or euthanasia. The legislative language in this section is about informing people of their options at this very difficult time, not about controlling their decisions. It looks quite positive and well thought-out.
40. Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.
Response: This is about having a standard of care that requires explaining options to all patients. Yes, government is setting some guidelines here (excellent ones, from my perspective), but also doing it “guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.” Sounds different when you see the actual legislative language, doesn’t it? Also, I don’t see anything here about estate taxes.
41. Page 425: Government provides approved list of end-of-life resources, guiding you in death.
Response: See preceding responses on end of life. This is here to terrify you about government agents killing you and your loved ones. It does nothing of the sort. This series of end-of-life claims is really quite shameless.
42. Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
Response: See preceding responses on end of life. Plus, consider that the House bill would mandate that doctors be paid to explain palliative care to patients, giving them time to provide full infromation about the the benefits and side effects of various treatments.
43. Page 429: Advance Care Planning Consult will be used to dictate treatment as patient’s health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT.
Response: I find this false claim to be just about as disgraceful as the earlier effort to play to racist fears about illegal immigrants. The House bill goes into great detail about how to preserve the dignity and personal responsibility of people nearing the end of life. Read it yourself and see what you think.
44. Page 430: Government will decide what level of treatments you may have at end-of-life.
Response: Same as for p. 425, 427, 429. The email author is seeing something that isn’t there. This particular section is about advanced directives, which are a well established set of end-of-life procedures. Please read it for yourself. This is an effort on the part of the email writer (and many others) to plant the fear that the government wants to kill your grandparents. Yes, the claim is as crazy as it sounds. Read the actual text for yourself!
45. Page 469: Community-based Home Medical Services: more payoffs for ACORN.
Response: I will leave it to others to determine what this obsession with ACORN is about. Apparently the email writer is convinced that any reference to “community” is a secret code word for transfer of our tax dollars to ACORN. This is a section about the “community-based medical home” concept. Read the section and determine for yourself whether the email writers are in touch with reality. Here’s a quote that comprises most of p. 469: “The organization provides medical home services under the supervision of and in close collaboration with the primary care or principal care physician or nurse practitioner designated by the beneficiary as his or her community-based medical home provider. The organization employs community health workers, including nurses or other non-physician practitioners, lay health workers, or other persons as determined appropriate by the Secretary, that assist the primary or principal care physician or nurse practitioner in chronic care management activities such as teaching self-care skills for managing chronic illnesses, transitional care services, care plansetting…” How you get from this to ACORN payoffs may be a matter best left to a mental health professional.
46. Page 472: Payments to Community-based organizations: more payoffs for ACORN.
Response: See previous responses re: ACORN-related paranoia.
47. Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.
Response: Again, this reasoning is pathological. Essentially, what we have here is a section mandating coverage for a particular service from a licensed mental health professional. It’s akin to saying that if the government mandates coverage for mental health services, that means the government is controlling your mind. At this point, do you trust the person writing this email to report accurately on anything at all?
48. Page 494: Government will cover mental health services: defining, creating and rationing those services.
Response: There has been a long history of insurance companies refusing to cover mental health services at parity with physical health services. This section seeks to redress that longstanding discrimination. The insurance companies have rationed mental health services for decades. This legislative language seeks to ensure greater access.
Having read the claims and the responses based on the actual text of the bill, what do you think now? Did the writer of the anti-health reform email seek to convey facts or to manipulate his/her readers with falsehoods? Remember this as you listen to the debate over the next couple of months and the false claims continue at a fast and furious pace.
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