NOTE: Obamagrandma and others have already posted on this. But I thought I'd add my voice to the growing chorus debunking this email.
You may have seen it: a snarky email that's going around, "summarizing" the first 500 pages of HR3200. Needless to say, it's a big ol' steaming pile of misinformation, misinterpretation and outright lies.
My response to things like this, generally, is to Reply All and bombard the entire recipient list with as many facts, or at least as much logic, as I can muster. And it occurred to me that others who are getting this email might be able to use it to give their friends and family something to think about, and maybe — just maybe — change their minds.
I'm self-employed, so I simply didn't have time to research and address every bit of absolute drivel contained in this little list. But here's a reality check on some of it, anyway. If anyone wants to correct anything I've said, or respond to a bullet point I ignored (especially on the tax stuff), or expand on one of my points, please feel free. I might even include it in an update.
Here's the text of the email:
"Here are a few highlights from the first 500 pages of the Healthcare bill in congress. This is a bit easier to read than 500 pages!!! Rather scary if this goes through!! We all need to let our representatives in Congress know our feelings on this, or else we are all in trouble if this passes.
- Page 22: Mandates audits of all employers that self-insure!
- Page 29: Admission: your health care will be rationed!
- Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
- Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.
- Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
- Page 58: Every person will be issued a National ID Healthcard.
- Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
- Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
- Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
- Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)
- Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
- Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
- Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
- 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.
- Page 127: The AMA sold doctors out: the government will set wages.
- Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
- Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.
- Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll
- 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
- Page 167: Any individual who doesn’t' have acceptable healthcare (according to the government) will be taxed 2.5% of income.
- Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
- Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
- Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.
- Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected."
- Page 241: Doctors: no matter what specialty you have, you'll all be paid the same (thanks, AMA!)
- Page 253: Government sets value of doctors' time, their professional judgment, etc.
- Page 265: Government mandates and controls productivity for private healthcare industries.
- Page 268: Government regulates rental and purchase of power-driven wheelchairs.
- Page 272: Cancer patients: welcome to the wonderful world of rationing!
- Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
- Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
- Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
- Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
- Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.
- Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
- Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
- Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
- Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
- Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
- 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.
- Page 425: Government provides approved list of end-of-life resources, guiding you in death.
- Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
- 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.
- Page 430: Government will decide what level of treatments you may have at end-of-life.
- Page 469: Community-based Home Medical Services: more payoffs for ACORN.
- Page 472: Payments to Community-based organizations: more payoffs for ACORN.
- Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.
- Page 494: Government will cover mental health services: defining, creating and rationing those services."
And here's my response:
Page 29: Admission: your health care will be rationed!
It's not polite to say this in mixed company, but healthcare is rationed right now. Insurance companies determine what procedures they will cover, and at what price. When they deny payment, patients must either go without care, or pay out of their own pocket. Without profit margins and a stock price to protect, a public plan will have far less incentive to ration by denying coverage. Instead, it will be driven by what is medically best for the patient.
Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
They already are — it's called the emergency room. In fact, illegal immigrants are specifically excluded from coverage in this bill. But that means only that they will have to continue to rely on emergency room visits - and because ER visits are expensive, hospitals end up passing those costs along to their insured patients. Whether we cover illegal immigrants or not, we'll be paying for their care one way or another. (If you're tempted to say that illegals should be turned away from the ER, ask yourself: Do you really want the guy washing dishes in your favorite restaurant, or picking the fruit you buy at the grocery store, or playing with his kids in your neighborhood park, to have swine flu or hepatitis B — but never be diagnosed because he isn't allowed to go to the doctor or even the ER?)
Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
This section has nothing to do with individual bank accounts; it applies only to insurers, and is meant to stop them from intentionally delaying the payment of claims. Intentional delays in payment are very common, and can cause financial hardship not only to patients, but to doctors and hospitals as well. It doesn't apply to anybody's private bank account.
Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
HR3200 doesn't mention ACORN, or SEIU, or any union or corporation. This section has to do with reinsurance, which applies to post-retirement health benefits and post-retirement medical benefits plans offered by many corporations — most of which don't even have unions. Reinsurance is a safety net to prevent an aging group (the one that's most likely to use their coverage) from being dropped into the risk pools when one of these plans is terminated, thereby putting too much strain on the system.
But seriously: ACORN? Are you sure our premiums won't be going straight to Lord Voldemort?
Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
There are many legal residents — and citizens — of the United States who speak English as a second language. When you're dealing with the complex and stressful issues of health care — understanding diagnoses and treatment, deciding whether or not to have a surgery, etc — wouldn't you want to communicate about them in the language you understand best? Or would you want to risk an overdose or the like because your language skills weren't up to the job of understanding the doctor's instructions?
Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
WRONG! But thanks for playing. Employers actually aren't allowed to offer only the public option — they can offer the exchange, which includes private insurance as well as the public option. This health care bill is ALL ABOUT alternatives.
Page 167: Any individual who doesn’t' have acceptable healthcare (according to the government) will be taxed 2.5% of income.
"Acceptable coverage," according to the government, includes just about any coverage that exists today. Including your employer-subsidized private plan, Medicaid and Medicare, Tricare, the VA, etc. You won't be taxed just because the government doesn't like the policy or provider you choose. I don't agree that people who don't have insurance should be taxed - but that's because I don't think anyone should be left out of the health care system. Everyone should be covered, whether or not they can afford to pay a premium or copay.
Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.
What it actually says is, "Not treated as tax for certain purposes." It has to do with determining tax credits, as per section 55 of the tax code. But maybe it's more fun to pretend it's a piece of doublespeak worthy of Lewis Carroll or George Orwell. Like calling a wholesale deregulation of, and massive giveaway to, the insurance companies the "Empower Patients First Act."
- Page 253: Government sets value of doctors' time, their professional judgment, etc.
Page 265: Government mandates and controls productivity for private healthcare industries.
Page 272: Cancer patients: welcome to the wonderful world of rationing!
Even if these were true (they're grossly oversimplified, at best), in our current system it's the insurance companies — whose purpose is to make a profit — that 'set the value' of doctors' time and judgment. (Doctors set their own fees, but they're constrained by what insurance will pay for.) I'd rather have a nonprofit public entity doing that, than a for-profit business whose bottom line depends on denying coverage. Incidentally, the value an insurance company places on a doctor's judgment is often a big, fat ZERO — they routinely deny coverage for treatments and procedures that doctors have recommended. Again, it needs to be said that insurance companies ration care by denying coverage. And you already have a bureaucracy between you and your doctor — but its sole concern is corporate profits.
Page 317: Doctors: you are now prohibited for [sic] owning and investing in healthcare companies!
There's actually very good reason for this one: A recent New Yorker article ("The Cost Conundrum," by Dr. Atul Gawande) revealed the fact that many doctors start up medical testing labs and other ancillary facilities so that they can make money by referring patients there. Let's see . . would owning a stake in the lab make a doctor more, or less, likely to send a patient there for unnecessary tests?
Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
"Outcome-based measures" means determining which procedures and treatments will yield the best results — or outcome — for a patient in general, or a specific patient in particular. It's about choosing a treatment that works for the patient, not just one that is "the way things are done." For instance, if a surgery costs more than medication, but will cure a patient's condition instead of just managing the symptoms (imagine a new but not-yet-mainstream procedure that could cure diabetes or Parkinson's or rheumatoid arthritis), choosing the surgery would be an outcome-based measure. By the same token, if removing a fibroid cyst from a woman's uterus costs more than a hysterectomy (since it's a more delicate procedure) but will preserve her fertility, choosing the fibroidectomy would be an outcome-based measure. Good luck getting approval for the more expensive, or more unconventional, of two treatments from a private insurer.
- Page 425: Government provides approved list of end-of-life resources, guiding you in death.
Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
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.
Page 430: Government will decide what level of treatments you may have at end-of-life.
Anyone credulous enough to believe these assertions, in particular, has definitely drunk the right-wing Kool-Aid. This section is about having your insurance plan pay for you to sit down with a doctor, discuss the options for advance directives (living wills, DNRs, medical powers of attorney, etc) and end-of-life care (hospice, in-home hospice, etc), and ensure that your wishes are known so that in the event you aren't able to make your own health care decisions, your family and your doctor will know what you want them to do. It's about educating patients and allowing them to determine how their care will be managed should they be unable to communicate their wishes in the moment. The patient is the one who determines what level of treatment they have at end of life, so they can avoid being a vegetable kept alive by machines — or use any and every "heroic measure" there is to keep their body alive as long as medical science can manage.
Can we please — at a bare minimum — be civil and rational enough to agree that the government is not hatching a secret plot to kill off the elderly?
As I said, this isn't a complete debunk of every one of the email's bullet points. I'll try to add to it . . . and I welcome the help of the fine minds here at DailyKos.
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UPDATE
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Thanks to AdrianInFlorida for providing responses to the following bullet points (I've paraphrased a bit):
Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
Nothing new here: many insurance plans offer "call a nurse" lines.
Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.
Many insurance companies cover marriage and family therapy. So by this logic, insurance companies are already "intervening" in your marriage.