Fuzzy’s Notes: HR 3200, Pages 355-454

Okay, so where was I? Ah, yes, scrolling sleepily through the Medicare/Medicaid expansion section of HR 3200. Fun, fun. Frankly, with these expansions and a tweak up in the income level for qualification, I don’t see why we wouldn’t have a darned good start on covering many of the people who are uninsured in this country because of cost (rather than choice, as many are).

I’ve found a very well-written and blessedly brief article (compared to my lengthy and often tangent-laden Notes) that beautifully sums up and addresses some of the more worrying issues associated with nationalizing our healthcare BO-style. Shawn Tully on CNN.com (yes, you read that right, CNN.com!) discusses the “Five Freedoms You’d Lose in Healthcare Reform,” and he does not distort what I’ve read in this House bill, and he is also talking about the Kennedy Senate version that I have not yet read (don’t worry, I probably won’t because it’ll all be moot before I can finish this one! Congress is back in session in, what?, a week? I’m not even halfway through this monstrosity yet.).

If you do go check out that article, be sure to scroll down and read some of the comments. They’re hilarious! One guy was all bent out of shape that an article that basically opposes (or at least exposes the truth about) the healthcare reform bills would be allowed on CNN.com. Can you imagine that we’ve come so far that people are telling NEWS organizations not to report facts and news with which they, the viewer/reader, don’t agree? Unbelievable. Walter Cronkite must be turning in his grave.

It’s also really cute the way the ignorant and ill-informed try to use words of two, even three!, syllables to demonstrate their complete lack of understanding about this bill and what this “reform” would actually be. Why aren’t they quoting the parts of the bill/s that expand coverage to everyone for free and that let everyone else keep their healthcare plans and that promise Utopia for all? Um, okay, that last part was a bit of hyperbole, but you will not find any liberal quoting from the bills to show that you’ll be able to keep your healthcare after five years or that you’ll be able to pick your own doctor. They can’t. The bills say what they say, and there’s no hiding that fact. Unless you bury your head in the sand and accuse everyone who HAS read it of “speculating,” “being unChristian/immoral,” or outright lying (as our Liar in Chief likes to do).

Maybe my next pet project will be to take each of the lies that BO tells and these silly, empty-headed Stepford citizens gobble up and copy in the portion/s of the bill that directly and clearly refute them. It won’t be hard, I’ve already done the initial read, have the page numbers listed for each . . . hmmm, yeah, that would be a good project.

But not until I’ve finished this one. So, without further ado, I’m going to pick up where I left off:

Fuzzy’s Notes: HR 3200, Pages 1-95
Fuzzy’s Notes: HR 3200, Pages 95-194
Fuzzy’s Notes: HR 3200, Pages 195-354

This will all be Medicare and Medicaid for a while, so if you want to skip it, by all means. I’ll draw attention to anything that seems critical, but so far it all seems pretty reasonable to me and makes you wonder why this hasn’t already been done. We all pay into Medicare our whole working lives, so what’s wrong with using that money when we need it? I don’t have any problem at all with Medicare or Social Security, though many Republicans are opposed to them (but shhhh, I’m not a Republican . . . yet. If this healthcare reform goes through as is, I’ll switch parties so fast, your head will spin).

1. Regarding Medicare: legislation to close the coverage gap (pg 355), increase initial coverage limit (pg 356), and decrease annual out of pocket threshold (pg 356). I’m all for that. And for once, I’m not being snarky. Drug rebates (from the manufacturer) for “dual eligible” Medicare and Medicaid peeps (pg 358-89). Drug discounts (pg 389-374). Again, prescription drug prices are ridiculous, and any legislation that can get that under control is A-OK in my book; well, let me qualify that, IF this were not a part of a national, government-run healthcare measure, I would support it. More on prescription drugs, apparently.

2. Repeals “provision RELATING TO SUBMISSION OF CLAIMS BY PHARMACIES LOCATED IN OR CONTRACTING WITH LONG-TERM CARE FACILITIES” (sorry for the caps, just copied and pasted it from pg 375).

Ugh, I think I’m just going to read all this and note anything that relates to everyone’s healthcare or is of interest; I’m in favor of Medicare reform and expansion, and I am willing to pay higher taxes for that, just as I am in favor of and support expansion of Medicaid to include more people than it now does–with the very big exception of coverage for illegal immigrants. That, I will always oppose. If you oppose such expansions, you know where to find the changes HR 3200 proposes.

3. Oops, looks like I spoke too soon. I absolutely do NOT support any use of tax payer money (no cost sharing, so this is totally on the tax payer’s dollar! (pg 414)) to “make available language services for beneficiaries who are limited English proficient and ways that Medicare should develop payment systems for language services” (pg 401). I know this drags up an old debate, but it’s still relevant, perhaps more so now than ever. If you move to a country, you need to learn that language and not expect the government of that country to accommodate you, much less to provide “on-site interpreters” (pg 402) and spend gazillions on translating everything under the sun that even remotely touches you (pg 417)! AND this provides for an interpreter at the doctor’s office, too (pg 403). How many friggin’ interpreters do we need to hire to drag around with every non-English speaking person on Mediare? What’s that going to cost? Can you imagine moving to Nairobi or China or heck, anywhere and demanding not only benefits but that they be given to you in English by a government-hired interpreter, one who tags along with you like an entourage of one? WTF? I’m shaky about giving just anyone Medicare, anyway, they should have to pay in for (say) twenty years before they can get it. That would give them time to learn English, and they would have earned the right to that benefit.

4. This chaps my hide, too! This bill also sets up twenty-four $500,000 (half a million dollars!) to medical providers so that they can learn another friggin’ language (pg 405). Are you kidding me? Who is going to need to spend half a million dollars to teach Spanish or whatever? Holy crap, just buy a bunch of software packages and hand those out if you have to teach languages! That’s what I did for my third language doctoral requirement. I used Learn to Speak French 8.1, and I got it on sale for ten bucks. Buy 24 of those at the whopping outlay of $519.12 (I just found it on amazon.com, and it goes for $21.63 there, I must have lucked out with my sale find). Actually, I don’t want taxpayers to pay even that! If doctors and other medical professionals want or need to learn a language, they can pay that themselves. Half a million dollars! Times 24! Outrageous.

5. The controversial end of life discussions are covered beginning on pages 425-42. I have to admit that I find the government involvement in this very distasteful. It is not the government’s business how I end my life or what discussions I have with my physician about that, and it’s certainly not up to the government to dictate, as it does here, the CONTENT of those discussions. Unbelievable. Sets up the health care proxy that many states already allow (pg 426), but this really is a state matter, not a federal matter, no? I know that the power to do this comes from the government’s involvement in the payment of medical expenses, but that right there is precisely why I don’t want the government paying a penny of my health insurance. Once they give you money, that’s it, they own you. They can rule, regulate, monitor, and basically do whatever they want. And they will. Ask the good people at GM, AIG, etc. if you don’t believe me.

6. Okay, I’ve finished that section, and I didn’t see anything in there that would result in “pulling of the plug on grandma.” The section stresses the individual’s decision and seems to make provisions to ensure that these are carried out. It’s really over-written, though, and as I am neither a lawyer nor a politician, I may not totally understand what the ‘order regarding life sustaining treatment’ means (pg 429), but it does read as though the individual decides their own end of life treatment or selects a proxy to do so in the event that they cannot communicate this themselves. I guess you could say that this sets up a government plan to “bully” the elderly into making a choice that means they “won’t be a burden” on the system (there seems room for this interpretation on pgs 431-32 because doctors will be required to file their end of life reports and to get approval for end of life decisions made about and by their patients; this could lead to the government providing a set list of end of life “options”), but that seems like a stretch to me. I’m just saying.

7. Finally got through with the Medicare section. Whew! Ah, and here is the physicians’ reward and incentives “pilot program” (443). Sigh. Yep, it’s true, they really ARE going to pay doctors more if they save money (pg 447-48) on medical “items and services” (pg 448); the implications are clear here. Save money by withholding costly tests and treatment, and we’ll send you a check. The stupidity of the government really knows no bounds, does it? I mean, really, what kind of a program is this? It’s set up to force doctors (who will be leaking money like crazy due to the government-run option; I’ve covered this already in earlier Notes) to give shoddy care to patients in order to keep their own financial heads above water. That’s cruel, really. And very sneaky. The government isn’t killing people directly this way, right? No, it’s holding a gun to a doctor’s head and forcing him to do it. Charles Manson didn’t kill anyone directly, either, remember? And he’s rotting in prison all the same. This is truly sick-making.

8. And it gets worse. In addition to this, the government will “periodically rebase” based on the “new” costs that are established by depriving people of medical items and services (pg 449). This means that once the first round of “savings” are calculated, the only way to get the incentives and rewards is for doctor’s to cut items and services still further! This is an absolute outrage!! I am . . . beyond words. My heart literally feels heavy reading this; it’s downright evil (and that is not a word I toss around). Just when I thought it couldn’t get any worse . . . the payments will be percentages of the money saved on medical items and services (pg 449-50)! The more you withhold, the more you make! So they ARE going to unplug grandma and deny treatment to everyone else, too! Unbelievable.

9. And believe it or not, it actually gets even worse! Administrative and judicial review of this “pilot program” are BANNED (pg 454):

‘‘(4) LIMITATIONS ON REVIEW.—There shall be
4 no administrative or judicial review under section
5 1869, section 1878, or otherwise of—
6 ‘‘(A) the elements, parameters, scope, and
7 duration of the pilot program;
8 ‘‘(B) the selection of qualifying ACOs for
9 the pilot program;
10 ‘‘(C) the establishment of targets, meas
11urement of performance, determinations with
12 respect to whether savings have been achieved
13 and the amount of savings;
14 ‘‘(D) determinations regarding whether, to
15 whom, and in what amounts incentive payments
16 are paid; and
17 ‘‘(E) decisions about the extension of the
18 program under subsection (g), expansion of the
19 program under subsection (h) or extensions
20 under subsection (i).

This can’t mean what it seems to mean; this program will operate outside the law? How is that even possible in America in the twenty-first century. I can’t be reading that right. Right? I mean, I really don’t like it when people start foaming at the mouth and calling everyone “Nazi,” but if I’m reading this right . . . OMG!

Honestly, I have to stop here. I can’t read anymore right now. I’m on the bottom of page 454, and I’ll pick it up again later.

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