Free Markets, Free People

Health care reform – on to step 2

Harry Reid sent a letter to Sen. Bernie Sanders saying he planned to introduce the public option in a month or so.  Democrats in the House aren’t waiting that long.  Again, assuming they know that their liberal agenda window is closing, “progressives” plan to get the most bang for their buck:

A leader of the House liberals’ caucus said Monday she’ll introduce new legislation to revive the public option.

Rep. Lynn Woolsey (D-Calif.), the co-chairwoman of the Congressional Progressive Caucus, said she plans to unveil legislation to add the government-run option to the national healthcare exchange established by legislation President Barack Obama is to sign tomorrow.

“We will introduce a robust public option bill on the very day the president signs the reconciliation bill into law,” Woolsey said Monday during an interview on MSNBC.

The public option, of course, is the precursor to single-payer and the progressive caucus has never been shy of telling anyone who will listen that’s what they want for real health care reform – a government run insurance program.

Meanwhile states are beginning to line up to file suit over the current bill which passed the House Sunday night – 11 or 12 states, including TX, FL and VA, plan on filing lawsuits upon the signing of the bill into law. FL, for instance, is claiming two elements of the bill are unconstitutional:

McCollum said the challenge is on two constitutional grounds: 1) its mandate that everyone must buy health care insurance, and 2) the new law challenges the sovereignty of states by forcing them to do things they cannot afford. He said the 10th Amendment protects states from that.

“It goes far beyond an unfunded mandate and would literally cost the state of Florida alone billions of dollars in additional costs to be able to implement,” McCollum said. “The whole bill is unconstitutional that it manipulates the state into doing things it cannot afford.”

If the individual mandate were to be ruled unconstitutional – and I think there’s a good chance there – it would cripple the law. One of the main funding provisions has to do with the mandates and fines for those who don’t comply. Of course if the court were to find for the states based on the 10th amendment argument (something I have no idea whether it has sound legal footing or not given the number of mandates the states presently have), the law would push all the cost back on the federal government and destroy any argument, however absurd, that it will reduce the deficit.

The point? The HCR debate is far from over. The left is going to continue to push for more and more add-ons to work toward their real goal – single payer, government run health care. The right is going to have to fight on two fronts – in the Congress where the 41st Senate vote will be very important and in the courts.

~McQ

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64 Responses to Health care reform – on to step 2

  • This bill is going to drive up premiums which will then push insurers out of business and further the aims of the statists. See here for details.

  • Well, it’s not as if we weren’t warned that this was going to be one very large bait-n-switch operation.  On the one hand, it’s pretty brazen to see them move to do this so quickly, but I think it’s as you said– the window of opportunity is closing very quickly and thus they’re going to try to get as much as they can before November, trusting that anything that makes it into a final bill will be difficult to remove later on.  I guess it’s time for Obama to whip out the trusty old teleprompter and get back out on the campaign trail.  I mean, he hasn’t made a speech in how long?

  • With something like 60% + of the country dead set against this sort of foolishness, it really gives lie to amy democrat claims to be representing the will of the people.

  • The commerce and spending clauses will quickly do away with a Tenth Amendment challenge, unfortunately.  That is unless the Supreme Court finally changes its analytical process on these issues.   I do agree that the penalty for refusing to buy insurance – without the exercise of a privilege, unless the government now thinks you should feel privileged that they let you live – is a violation of due process.

    • I suspect several justicies would love to slap this sh*t down with a solid 10 Amendment ruling.

  • Again, does there not need to be an injured party first?
    And then even when they get in the door, it will still be a hard sell.
     
    Cheers.

    • You can have standing to bring this type of challenge when you can demonstrate that you are within the scope of parties intended to be affected by the new law, and that enforcement is nearly certain if the law is enacted.

      • This is all fascinating stuff.
        Do you know of any examples I can look at for the benefit of my understanding?
         
        Cheers.

    • The state is the injured party. It is the subject of the mandates. It also argues that the federal government has no constitutional right to require any citizen of their state to buy anything and in the case of several, have passed laws stating that.

      • But the federal government passes down mandates to the states all the time.  It’s business as usual.
        If the SCOTUS deemed mandates unconstitutional, wouldn’t that just about throw our system into chaos?

        Not that that’s a bad thing.
         
        Cheers.

  • A majority of Americans have been consistently against this Health Care Reform attempt without even knowing many of the details in this bill. Their opinion has been based on the obvious which are added national debt we cannot afford, ugliness of the process, lack of bipartisan support and a massive intrusion of government into our health care system. When they learn more about the details over the coming months, such as the role of the IRS as enforcers of the mandates, they will be even more vehemently against this bill. What the Democrats passed last Sunday night might better be named the “Be Careful, You Might Get What You Asked For Act” and could still very easily turn into Obama’s Waterloo. With anything this complex and contentious, there is bound to be turmoil during its implementation which will involve the establishment of a new giant government bureacracy. Lawsuits, repeal attempts and citizen demonstrations will further raise the level of anxiety and uncertainty in the minds of many businesses and individuals. Once the euphoria wears off, the unintended consequences that will result could make passage of this bill an albatross around the neck of Democrats for years to come.

  • When states sued on issues such as seat belt laws and the 21 year age for drinking, the way the Federal government got around it was connecting various forms of money (such as highway funds) to that law.  Conceivably if an individual mandate is ruled unconstitutional, the Federal government could come back to states and say that if you want your money for X, you need to pass laws requiring an individual mandate.

    • As usual it escapes your notice that Representatives and Senators actually come from STATES.

      • That may not matter.  My state growing up, South Dakota, fought against raising the drinking age.  Enough Senators and Representatives disagreed with what the South Dakota state government wanted to do, and the Reagan Administration forced us to increase our drinking age.  If you have enough states wanting to prevent this, and if the Senators and Reps from the state agree with the state government, they may not pass such a bill.   However, historically it has happened.  (For the record, I believe state powers should trump federal powers on this).

        • Scott, the difference is that your examples were tied to highway construction.  The idea behind the drinking age was drunk driving (MADD, ya’ know).  It would certainly seem strange for the feds to tie highway funds to a mandate that all purchase health insurance.
           
          The second problem is the unfunded Medicaid mandate ( and the favoring of Nebraska over other states).    We have states on the verge of bankruptcy.  Several of the states, like Tennessee) have tried to fund health care and failed.  What does it gain the federal government to mandate Medicare expenditures if the state goes bankrupt.

  • Three points:

    1. Y’all keep saying Americans oppose this plan. I don’t think that means what you think it means. In a new CNN poll, that mirrors of numerous other polls that ask more than just oppose or support, roughly one in five of respondents who said they opposed the bill did so because it was not liberal enough, and those people are unlikely to vote Republican. Take them out of the picture and opposition to the bill because it is too liberal is 43 percent. In other words, 52 percent either support the current legislation or think it should be more liberal while 43 percent believe the plan is too liberal. Or, if want to try an make political points, just argue that a clear a majority of Americans stand with you in opposition to this bill, even though the reality a portion of your majority that makes it a majority are standing so far away from you, they are on the other side of the people who you think you are opposing. This isn’t strange bedfellows, this is the enemy of your enemy is way worse than your enemy.

    2. I’m not going to bother explaining the Supremacy Clause, or just how inane and pointless the Tenth Amendment argument is. Instead, let me show you a law that the Founders, the 5th Congress with President John Adams to be precise, passed in 1798. President Adams signed into law “An Act for the Relief of Sick and Disabled Seamen.” This law mandated a payroll tax on privately employed sailors to pay for a federal single payer healthcare insurance system. It also authorized the construction of federal hospitals.
    How would anyone argue that the Founders did not believe the federal government could not mandate insurance when the founders did indeed mandate insurance. Those commies!

    3. Assume for a moment that the Tenth Amendment argument DID succeed. While Republicans are aguing they are the true custodians of Medicare (LMAO), they would be pursuing a legal ruling that would immediately make Medicare unconstitutional. Medicare mandates particpation by every worker in America, and ny particpation, I mean payment. Sure, you can pay for Medicare and then go out and pay out of pocket for any medical treatment rather than use the program,  but you cannot exempt yourself from particpation. Just as this mandate requires that you carry a minimun level of health insurance, it does not mandate that you use the insurance, you would be welcomed to pay medical providers directly and never submit claims. For that matter, Social Security would be invalidated if the 10th Amendment argument were successful.

    Of course this is all silly, even if these people find a court that rules in their favor, and even if the Supreme Court were to rule in their favor (they won’t), the solution to overcome would be simple, the power of the purse. The fed would simply change the law to encourage states to adopt mandates without legally requiring the mandate at the federal level. States that participate would get federal funding, states that did not would be denied federal funding. Considering the primarily red state support of the tenther argument, and the fact that these states are the biggest teat suckers with respect to less taxes into the fed and more federal funds into the state, they would be changing their laws faster than you can say “death panel”.

    • I hope by your name that this entire post was tongue-in-cheek.  Because if it’s not, it’s completely disingenuous and misleading.

      1.  Whether the bill is unpopular or not has nothing to do with its viability under the Constitution.

      2.  You’re not going to bother with the supremacy clause or the Tenth Amendment because you understand neither.  Your citation to the Act for the Relief of Sick and Disabled Seamen as analogous to a single-payer healthcare system is an outright fabrication taken from the democratic underground.  That Act provided that merchants were to be taxed – which could then be passed on to the wages of the crew members – for the purpose of the “relief and maintenance of sick or disabled seamen.”  The purpose was because seamen were poorly cared for and discarded on American shores to become someone else’s problem. 

      This “tax” was levied on members of a specific profession who could conveniently opt out by choosing not to be engaged in the merchant trade.  To suggest that this means the founding fathers – who are somehow represented by the Fifth Congress nearly 20 years after the Constitution was ratified – envisioned a universal graduated tax to be avoided by none and redistributed as the government sees fit is ridiculous.

      3.  Medicare and Social Security do not involve the states at all, so I fail to see how that is in any way germane to this Tenth Amendment conversation.  In no way would a ruling on this issue affect Medicare.  (Although possibly it should.)

      • Your point three is right on the money, TW.
        Now, if Congress had enabled us to buy health insurance across state lines, they would have firmer footing for the mandate.  (I still think they’d be wrong, but at least it would involve interstate commerce.)

    • And again, you, like Erb, choose to ignore that the people who draft legislation originate IN STATES.  And a collection of like minded representatives, FROM STATES, could pass a bill in the house that invalidates all your arguments about Federal controls, and a similar bill could be passed in the SENATE, by SENATORS, FROM STATES, who can limit Federal Control.
       
      The problem is, and we ALL do it, we treat the Federal government as if it is an entity peopled, populated and run by third party aliens who do not get there as representatives of the population OF STATES.
       
      Just as a collection of turds gave us Federal Mandates to pay for their local pork, we could in theory (okay, even I’m laughing hysterically at this idea) get a collection of Representatives that would rescind all this Federal Control crap.

      • This is true, but the stupid electorate re-elects incumbents 88% of the time because they believe the problems always lie with someone else’s senator, not their own.  So the federal government does operate as a de facto alien body, with people from other states imposing their will on your state without your consent.  Avoidance of this was the whole concept behind federalism, a lesson the federal government forgot long ago.

  • I think that I wrote in comments here last summer that the flying saucers could be attacking the Capitol dome with death rays and the Democrats would be inside still pushing the public option.

  • I think the individual mandate might be a bridge too far. I credit the arguments of folks who say that based on USSC precedent one can make a strong case that an individual mandate would be upheld. I can see the legal reasoning and understand it. Plus, no doubt there are some justices who would be thinking, “Well gee, they’ve got to have a mandate for this thing to work. So I have to figure out a way to justify it.”
    Don’t misunderstand me here. I’m not making the same mistake a lot of us did about campaign finance reform where we thought it was obvious that the law was a clear violation of the First Amendment and would certainly be struck down. I do think that the question they will have to address is so fundamental to the idea of personal liberty that even Justice Kennedy might think twice before ruling to uphold the law. A favorable ruling for the government would be a grant of power so far reaching that the consequences are almost unimaginable. The Supreme Court would effectively be ruling that there were no limits to Congressional power. Can you imagine that would be acceptable to the populace? With no limit in law to government power, we are no longer free. We have become appendages of the state.
     

  • TW,  your entire statement is as accurate as your assertion that “To suggest that this means the founding fathers – who are somehow represented by the Fifth Congress nearly 20 years after the Constitution was ratified”.

    I not only posted that it was the 5th Congress (2 year terms x 5) but I posted the year the law was passed, 1798.

    If you only knew when the Constitution was ratified, you could have theoretically worked this out without removing your socks.

    Medicare and Medicaid have as much to do with states as this HC bill does, it compels citizens of states to compulsory participation in federal plans, and if the federal law establishing this bill is a violation of the Tenth Amendment, then the federal law establishing Medicare is a violation as well. There are advantages and disadvantages to a strong federal government, but you folks cannot seriously believe that at this stage in our history, we are not one nation, but just a collection of sovereign states.

    Interesting that you point out the reasoning behind the Act for the Relief of Sick and Disabled Seamen, as that rationale, that the seamen were poorly cared for and discarded on American shores to become someone else’s problem, is analgous to the rationale behind the current HC bill. Millions of Americans are left stranded by the private insurance system every year because the private insurers deem them to be unprofitable, and because of COBRA (you know, the law passed through the reconciliation process under Ronald Reagan and a Republican Senate in 1985) mandated (unfunded) that no one could be denied necessary medical care, many of those people DO eventually get treatment, but taxpayers foot the bill, essentially subsidizing the insurance industry. Not to mention the huge subsidy to the insurance industry that Medicare itself represents, just when Americans are hitting the most expensive period of medical care in their lives, insurance companies are relieved of the burden of even trying to cover them, and we the taxpayers take over.

    The private insurance industry, to the extent that it should perform a necessary and vital service in this country, but as a capitalist enterprise, beholden to shareholders first and foremost (that is a corporation’s responsibility, nothing wrong or evil about that), is analgous to paying someone to clean your sofa, and their cleaning efforts consist of picking up all the loose change, and leaving the rest of the mess for you.

    • COBRA – for the year you’re allowed to carry it (that is, the year YOU’RE allowed to pay the premiums for the coverage…) it’s not free to you.
       
       
       

      • looker, COBRA was a bill, the Consolidated Omnibus Reconciliation Act, and although we have used COBRA as the name of the policy that extends employer benefits to employees after they have left the business, there was a LOT more to that bill than just that. Among other things in the bill was the enactment of the “Emergency Medical Treatment and Active Labor Act” or “EMTALA” which makes it a legally requirement that healthcare providers provide necessary screening and treatment to anyone wihtout regard (and without asking) about their ability or intention to pay for treatment.

        There is not requirement to provide the treatment for free, but this mandated treatment is the source of most unpaid medical bills, which of course we the taxpayer end up paying in one form or another.
        Although this mandate as unfunded, it really represents the moment when America codified guaranteed national care.

        • Hey, dude, I’m intimately familiar with how COBRA works since I paid to carry it for the year it was effective after the other employer provided insurance went away….
          How bout you?
           
          I must have missed the month where YOU paid my bill that year, sorry, how ungrateful of me.

          • Oh, and I’ll let ya have a chat with #3 son, who’s got about 10k in hospital bills he’s paying off because he didn’t have insurance, he, also, is waiting for his taxpayer bailout (wrong race, wrong ethnicity, having to pay for it himself…what a bitch….)
             
            You guys who are covering us are really falling behind, we’re having to choose between beer and medical bills, let’s get with the program and get those checks rolling will ya?

  •  
    The $64 dollar question …
    with ObamaCare’s the government’s “Medical Advisory Board” now able to make some health care decisions for you, does this undermine Roe v Wade‘s “privacy” underpinnings, as the government already has a seat at the decision table ?
    .. or more simply, could a socially conservative administration now outlaw abortion ?
    The answer to that question became a lot murkier Saturday night.
    The converse is also interesting .. is the “Medical Advisory Board” unconstitutional because it flies in the face of years of privacy precedents from the SCOTUS such as those built on Roe v Wade ?

  • How can the US compel citizens to procure a product as a condition of citizenship?  Can anyone show any other such similar law:  as a condition of citizenship you must buy X?

  • Read the bill Neo, the Medical Advisory Board is on page 1001, and it is not responsible for reviewing ANY individual medical decisions, but is charged with making proposals to improve the efficiency of Medicare. The board has no power to implement any proposals, just to make proposals to be presented to Congress, who can then choose to implement all, part, or none of the board’s proposals.

    My question is why don’t you know this, and where you got the information that put you in the position of making this wildly inaccurate statement. Shouldn’t you be angry at them (Glenn, Rush, Sarah, Sean, Boehner) for misinforming you so badly?

    Oh, and there are prohibitions on what this Medical Advisory Board may even propose, for example:

    ‘‘(ii) The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria.

    • Here is the page, Neo.
      I think you owe the good Captin here $64… Or at least a year supply of Rice-a-roni;)
       
      Cheers.

      • Yeah, well, before you two dance in the aisles about the privacy issue not being a concern for your Medicare advisory board, why don’t you check out –
        SEC. 3502. ESTABLISHING COMMUNITY HEALTH TEAMS TO
        SUPPORT THE PATIENT-CENTERED MEDICAL HOME.
        (snip)
        (i) collect and report data that permits evaluation of the success of the collaborative effort on patient outcomes, including collection of data on patient experience of care, and identification of areas for improvement; and…
        (snip)
        1 (d) REQUIREMENT FOR PRIMARY CARE PROVIDERS.—A provider who contracts with a care team
        shall— (1) provide a care plan to the care team for each patient participant;
        (2) provide access to participant health records;
        and (3) meet regularly with the care team to ensure integration of care.
        And finally to tie it all up –
        (e) REPORTING TO SECRETARY.—An entity that receives a grant or contract under subsection (a) shall submit to the Secretary a report that describes and evaluates, as requested by the Secretary, the activities carried out by the entity under subsection (c).
        (What does “as requested by the Secretary” mean?  That Abortion still ‘private’ if Mr or MS Dr has contracted with one of the managed care home team?)
         

    • And there is this:

      The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers. Starting in 2014, the panel’s recommendations would take effect unless federal lawmakers substitute their own reductions.

      from here.

  • How can the US compel citizens to procure a product as a condition of citizenship?  Can anyone show any other such similar law:  as a condition of citizenship you must buy X?

    First, there are exemptions, both economic, and religious, but beyond that, you must buy Social Security Insurance and you must buy Medicare insurance.

    If you wish to argue that using the force of the federal goverment to buy a product from private industry, I can see that, but I think that arguement might be the quickest route to a single payer or federal exchange plan, so, go for it, I’ll support that argument.

    I think a big part of the mandate arguement that favors the fed is the manner of penalty, it is essentially a tax, and while you can debate the enumerated powers until you are blue in the face, there is no debate on the fed’s power to tax. Congress could probably just remove the mandate language but leave in the penalty tax language. It’s not a mandate, we are just going to tax you if you don’t have insurance. See how easy that was.

    • In 2014 the law REQUIRES you to procure health insurance.  You will be give a tax credit but you must procure insurance.

      No law requires you to pay SS taxes or medicare taxes if you don’t work.

      • You aren’t required to pay the Health Insurance fees if you’re dead.  It’s the same, see?

  • No law requires you to pay SS taxes or medicare taxes if you don’t work.

    There are several exemptions available, including inability to afford coverage.

    • There are provisions that cover you if you’re below a certain income level and don’t have insurance – well, they don’t charge the penalty anyway.

    • No, you’ll be issued a credit for which you must procure health insurance.

    • No, you’ll be issued a credit for which you must procure health insurance.

  • looker,  on your post discussing your intimacy with COBRA, you still misunderstand. COBRA was a VERY large bill passed in 1985 that legislated FAR more than just benefit extensions. It also required, by law, that medical providers treat anyone in need of care without regard, and without asking about, their ability to pay.

    This part of the COBRA bill was called EMTALA.

    Get it yet?

    • “It also required, by law, that medical providers treat anyone in need of care without regard, and without asking about, their ability to pay.”
       
      No Captain, it did not.  It only covered emergency care.  No one can walk into their local doctor and demand treatment.  So, when you hurl your stupid insults, you really ought to make sure you actually understand the provisions or you look particularly dumb.   Of course accuracy is not all that important to you.  Just the sarcasm.   Why is sarcasm to important to you?  Inferiority complex acting up again?

    • Cap,  I was grumpy – I get it.   Let me point out that any time YOU or I walk into a hospital, we sign papers that says, regardless of how it happens, WE’RE responsible for the bill, not the US taxpayer is responsible.   Yeah, I know, we sign under duress, but there it is.  WE’RE responsible.   Again, life’s a bitch.

      As to EMTALA and COBRA –  Let me suggest that under the justification (that we passed  a bill in 1985) you’re using for why we should accept this,  I can suggest we reinstitute some form of slavery, because we had laws on the books back in 1786 that allowed for it, and it was the law of the land for many many years, and, well, there it was, it was even allowed for by the sacred founding fathers.  Already was in place, so, accept it.

      Get the idea?

      The fact that something has precedent, or was passed by some majority, or was done, or has been in place for any extended, or non extended period of time, does not make it right, or just, or good, or useful, or economic.

      And this last bill has certainly NOT been honest, you know it, and the rest of us here know it.  Yet you defend it, I can’t tell just as devil’s advocate, or because you genuniely agree with it.  One way or another it was not done in an honest, open fashion, and all the promises they made to get it in place, and many many of the actions and methods that used to do it, were in direct contradiction to an untold number of promises that were made by the very same people who did it when they were trying to get into power.

      Yet you believe it’s going to bring goodness and light and deliver these new ‘promises’ that were made, even if the new promises made contradict the old ones.

      You’re smarter than that man.

  • COMMUNITY HEALTH TEAMS –

    Looker, this is probably the most well thought out provision of this bill, notwithstanding your complete failure to understand it or the purpose and benefits of this provision.

    This provision is essentially an experiment. The government will fund teams of private healthcare professionals, including a care coordinator (most likely a GP) who will then select chronically ill patients (specifically chronically ill, not just, for example, some pregnant woman), and these eligible patients will have the option of particpating in the program, voluntarily agreeing to share their medical information with all of the members of the private care team for the purpose of determining the effectiveness of coordinated care.

    The teams will then provide coordinated care, with knowledge of what each other is doing with respect to the patient. They will then submit the results of the experiments to the Secretary, but not the private medical information of the patient.

    Based on the outcomes, it may be determined that Medicare costs can be reduced AND patient treatment can be improved, if the plans include coverage of a care coordinator for chronically ill individuals.

    If you have ever known chrinically ill individuals, people who have multiple acute conditions, you would understand that it is typical for these people to see several healthcare professionals, with each not knowing precisely what each other are doing. In many cases, treatments and medications are either duplicated, or contradictory, reducing the effectiveness of treatment and increasing the cost.

    If you took the same attitude toward reading the Bill of Rights, you’d interpret the Third Amendment as an order to make soldiers sleep outside.

    • “with each not knowing precisely what each other are doing”

      Gee, all my doctors already send reports to the other ones. Sometimes they even telephone each other. And they all hae me do histories for them annually, not to mention the conversations we have at my regular visits. What kind of ‘experiment’ is it when it is already commonly done? I guess this just shows how little our Congress actually knows about the practice of medicine. Not awfully reassuring.  

      • Uh, you had to sign waivers for that to  happen.  It is called HIPA.  In other words, you agreed to the release.  That is not the case with a government maintained medical records repository.    I can’t remember:  How long was it after Joe the plumber talked to Obama that his private records were in the public domain?  But, I am sure that could never happen with medical records.  Right???

        • “Uh, you had to sign waivers for that to  happen…”

          So? What is your point?

          Also, what is the difference since, according to CS’s comment,-
          “… these eligible patients will have the option of particpating in the program, voluntarily agreeing to share their medical information…”

    • Funny, I read that section, the Pharma appeared to relate to Chronic – the Home Teams not so much?  You must have read between the lines on that, I didn’t see heavy emphasis on CHRONIC in there.  Guess I better look again.

    • “This provision is essentially an experiment. The government will fund teams of private healthcare professionals, including a care coordinator (most likely a GP) who will then select chronically ill patients (specifically chronically ill, not just, for example, some pregnant woman), and these eligible patients will have the option of particpating in the program, voluntarily agreeing to share their medical information with all of the members of the private care team for the purpose of determining the effectiveness of coordinated care.
      The teams will then provide coordinated care, with knowledge of what each other is doing with respect to the patient. They will then submit the results of the experiments to the Secretary, but not the private medical information of the patient.”
      Well, those interested can read and correct me, won’t be the first time – here’s what I think I see….

      Subtitle F—Health Care Quality Improvements – nothing in there about CHRONIC cap –

      TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

       
      Now there is  a TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING  PUBLIC HEALTH but your fantasy must lie somewhere in there, not under the HEALTH TEAM section.

      I suggest in your carefully crafted reading and intrepretation you find another answer, because
      here’s the purpose – clearly stated in the document.

       
      (a) IN GENERAL.—The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall establish a program to provide grants to or enter into contracts with eligible entities to establish community-based interdisciplinary, interprofessional teams (referred to in this section as ‘‘health teams’’) to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the eligible entities. Grants or contracts shall be used to—
       
      (1) establish health teams to provide support services to primary care providers; and
      (2) provide capitated payments to primary careproviders as determined by the Secretary.
       

       
      The word CHRONIC isn’t in there.

      And it’s not voluntary to the patient if THEIR provider interfaces with the teams, unless of course the Doctor asks first and the patient decides rather than do that they they’ll seek other services elswhere.  No “sign up for this” about it. 

  • “The government will fund teams of private healthcare professionals, including a care coordinator (most likely a GP) who will then select chronically ill patients (specifically chronically ill, not just, for example, some pregnant woman), and these eligible patients will have the option of particpating in the program, voluntarily agreeing to share their medical information with all of the members of the private care team for the purpose of determining the effectiveness of coordinated care.”
    I tried to  come up with something substantive here, but I’m sorry. I can’t. I’m laughing too hard.
    Do you actually believe this? Seriously? Oh, man, you’re a fool, dude. The only obligation the government is gonna fulfill re: this health care fiasco is the obligation to take your money. Who you gonna sue or complain to WHEN (not IF) the quality of health care in the US declines dramatically?
    Who is gonna enforce this? What, you gonna bring all 43,023 pages of the health care bill with you every time to the doctor’s office and gonna point out: “Well, according to subset B, clause 812 of the Tongue Depressor Act of 2012….” You think your doctor or nurse etc. is gonna give a rat’s ass about what a law says or doesn’t say?
    And again, who will you turn to when the Man says, “Here’s your health care. Get lost.”
    ‘B-b-b-ut Captain Sarcastic still has the sniffles, and I want to–”
    “Get lost!”
    ‘O-o-okay, Mr. Government Health care Man’
    It’ll be you and your Pocket Health Care Reform Act/Obama Love Poems against The Man. Will it just be like all those times when your awesome knowledge of traffic laws helped you talk your way out of that speeding ticket? Because we all now how much The Man cares just loves bantering about law and its many applications.
    Or how about the time you used arcane Postal Service regulations to entice the 81341 Zip Code Branchto work really really really extra hard because, gosh darn, you really need your mail delivered quickly!???
    Or what happens when you go to the doctor and THEY declare you’re cured, and YOU say you’re still sick and then they DENY you care? What then? Huh? What?
    When every single effing doctor you go to has access to your medical charts: “Uh, sorry, Capt. Sarc, Govt Form 141013 here says your withering penis rash has been cured. So it must be so. Now Hope and Change with you! Run along now. Ta-ta!”
    Watch the first 20 minutes of Saving Private Ryan. That’s the kind of H.C. chronically ill patients are gonna get with this new “plan.” Divide ‘em up into 2 groups: those we can save and those we can’t. Next!

  • time, integrated health teams will do more than share information, and though you may make your care providers of any other care providers, many Medicare recipients do not. The experiment is not so much to determine that integrated care is effective, it is, but whether it can be done in a cost effective manner is the test. Numerous medical teams around the country will try develop models to determine a model that provides both effective medicine, and cost effective medicine.

    comeonplease, sell crazy somewhere else, your ramble made absolutely no sense at all. You are making arguments about government employed care providers, and there is simple none of that in this bill, except for these small, contracts given to private care integrated health teams, who will report on their effectiveness to see if a private  model for cost effective care can be duplicated and expanded.

    • “whether it can be done in a cost effective manner is the test.”

      I think, since it is already being done, the answer is already out there. They could aks the Mayo Clinic, for example, who have been doing this for years (http://www.mayoclinic.org/tradition-heritage/model-care.html).  Of course politicians, bureaucrats, and their groupies all think that nothing good exists, or can exist,  unless they originate it. 

      ” though you may make your care providers of any other care providers, many Medicare recipients do not”

      ????

    • And then there is the time factor. Somehow the impact of millions of new patients on doctors’s schedules has not gotten much attention. Somehow the picture of a group of doctors sitting around discussing each patient (this is IN ADDITION to regular doctor-patient time) is a bit amusing, and certainly not very plausible. Most doctors already have full schedules. That is why you have to schedule an appointment in advance.

  • Ok, I’ll ask again, who is gonna enforce the provisions in the health care bill?
    Health insurance is not health care. What if you you don’t get health care?  Who determines when health care has been provided? What if the state decides you’re healed, but you say you’re not? Does that make sense, CS? Clear enough for ya, pal?
    As for being crazy, I love it. What a joke. You tell me no one is going to be employed by the State… er, uh, argh, well, except for those “Numerous medical teams around the country…” What a disingenuous clown you are.  Right, no doctors employed by the State, just those who will be determining what treatments every other doctor will administer. Gotcha. Give me Liberty or give me a course of medical treatment that’s okayed by the State!

    As for all doctors not being employees of the state, eventually they will be. That’s always where systems like this lead. Are there any provisions in the bill preventing doctors from totally opting out of the system? If not, then how is that much different than being employees of the state?
     

  • That’s where systems like this lead?

    We know that every industrialized country on earth has some form of universal healthcare, but only some of them have publically employed medical services delivery, and these are the least effective of the programs, so no, to say that this is a definitive slippery slope to a publically owned medical industry is simply false.

    And there are no provisions in any bills anywhere that prevent doctors from totally opting out of ANY insurance assignement, including Medicare, Medicaid, or even private insurance.

    The Integrated Care Team trial has a specific end date, and if the experiement works to provide a model for care, future care teams will not be government contracts, but Medicare will pay benefits based on the model.

    Private doctors now determine if health care is and has been provided and will do so in the future. I have no doubt that going forward, just as in the past, there will be situations where the benefits do not cover the doctor recommended treatement. However, this is MUCH more prevalent under private insurance than it is under Medicare.

    You just have very little understanding of the current system, and the reforms this bill will provide, so you resort to basically either making up stuff, or repeating the misinformation of other idiots.

    • “You just have very little understanding of the current system, and the reforms this bill will provide, so you resort to basically either making up stuff, or repeating the misinformation of other idiots.”
      May I, not so politely I suppose, inquire if that’s where your understanding of the “Health Teams” and their purpose under Title III originated?

    • A little help – nothing ‘experimental’ about this – it’s a long term plan, not an ‘experiment’.
      Page 1067 of the document you’re an expert on….aside from confusing this full time organization with an ‘experiment in Chronic care treatment” I mean.
      TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
      Subtitle F—Health Care Quality Improvements
      (a) IN GENERAL.—The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall establish a program to provide grants to or enter into contracts with eligible entities to establish community-based interdisciplinary, interprofessional teams (referred to in this section as ‘‘health teams’’) to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the eligible entities. Grants or contracts shall be used to—

      (1) establish health teams to provide support services to primary care providers; and
      (2) provide capitated payments to primary careproviders as determined by the Secretary.

    • “there will be situations where the benefits do not cover the doctor recommended treatment. However, this is MUCH more prevalent under private insurance than it is under Medicare.”

      Not according to that bastion of conservatism, the AMA.  According to its 2008 National Health Insurer Report Card, Medicare denied coverage 170% as much as the entire private health insurance market combined.  But, then again, we know that facts don’t matter as much to you as talking points you can cut and paste from Democratic Underground.  You seem to hold all of the leftist positions on this issue but you aren’t in command of the propaganda. 

      In regard to the “advisory” panels, your credulousness is laughable.  You’re making yourself look like an idiot.   The code section you cited is meaningless.  Just because the advisory board cannot make recommendations or implement care decisions on its own doesn’t mean that the Secretary of Health and Human Services (or whichever apparatchik ends up running this monstrosity) won’t use the findings of the advisory board to deny care.  They will justify their decision by citing the “experts” on the panel – “the experts say that the cost of that treatment outweighs the benefit” etc. etc.  The NHS in Great Britain has NICE and the WHO just reported that cost-benefit panels are springing up around the world in socialized systems.  Obama told the New York Times that he wants to create just such a panel of elitist experts to make decisions for all of us about expensive end of life care because in his words, 

                 “It is very difficult to imagine the country making those decisions just through the normal political  channels.  And that’s part of why you have to have some independent group that can give you guidance.”

      I’ll help you out hotshot, that means that Obama wants to avoid the democratic process and appoint “experts” to decide the quality and quantity of healthcare that the proles get.  He says it won’t be “determinative” whatever that means, but since he has been so honest about things like leaving bills on line for 5 days before signing, closing Guantanamo in the first 100 days of his tenure, not hiring lobbysists, etc.  I’m not as trusting as you are. 

      As the AMA study found, the government is already the undisputed champion at denying care.  But they don’t even need to use “expert” panels to determine what is good for us stupid rubes.  They have another tactic at their disposal that will help them avoid the politically unseemly act of denying care, they will use rationing.  Long wait lists exist in every single socialized system on earth – Canada has them, England has them Sweden has them, etc., etc.  I know leftists like to deny that reality but it’s a fact.  If you get cancer in England  and die while you are waiting for treatment (like the 40% who never receive treatment) you lighten the load for the benevolent bureaucrats and stop stop burdening the system – win win. 

      In his sophomoric, town hall meeting analogy, Obama explicitly said that if there is a blue pill and a red pill “and the blue pill works just as well” but costs half as much then the patient should take the blue pill.  Who the hell do you think he was referring to as the decision maker and the enforcer of that determination?  He was talking about big brother making that decision.  We, along with our docotrs, can obviously make that decision for ourselves.  We don’t need Obama or his “experts” deciding whehter or not the blue pill works just as well as the red pill.  When Obamacare has succeeded in putting private health insurance out of business, the public option that has already been proposed in the House will make that setermination for us, your brilliant legal analysis notwithstanding.  As an added bonus, as is currently the case with Medicare,  the proles will have absolutely no recourse to sue for denial of care. 

      You can keep making stupid denials as long as you want, but Obama, Jan Schakowsky and anyone else with more than a double digit IQ knows where this whole process is heading.  You can bank on the fact that our benevolent superiors in the federal government will be using the advisory panels findings and anything else they damn well please to deny coverage. 

  • looker, I’ll accept fault for this, but I think we have been comparing multiple different provisions while trying to discuss the original argument. We started at the Medical Advisory Board, which Neo incorrectly understood to be a board that reviews individual patient cases and rules on treatment. I referenced that part of the bill to show that this board makes overall recommendations to Congress on a policy level, not a patient level. Then, after we dispensed with that, you brought up Community Health Teams, suggesting that these teams would make individual treatment determinations, I guess suggesting that these would be the “death panels” or something of the sort. I again referenced the bill, regarding health teams, and I again reference the bill, but made an error by paraphrasing from memory instead of referring to the bill language, and I referenced an entirely different section than the Community Health Teams section. You are correct, I was wrong. That section is not the section on experimental development of health teams referenced under Part III – Encouraging Development of New Patient Care Models. 
    You were wrong as to the implication that these Commuity Health Teams would be anything remotely resembling a government panel deciding care. The Community Health Teams section is an already approved model. Private care providers that have already established, or wish to establish in the future, interdisciplinary teams need to provide what amounts to their business plan to Medicare, and upon approval, they will be eligible to receive grants or contracts to establish these Community Health Teams. I would encourage you to read this entire section again. It essentially privatizes and localizes medical care, with Medicare paying the ultimate bill, but these teams would be responsible for coordinating care at the patient level, and paying the various individual medical providers outside of the team.

    I apologize for my error.

    Back to the original point, do you still think you see government panels making healthcare decisions for patients? I have seen absolutely zero references anywhere in the bill that allows for government discrimination on eligibility for benefits. If a treatment is covered, then it s covered for anyone and cannot be withheld by government decisions. In fact, no proposal can even be offered by the Medical Advisory Board to withhold care in such a manner.
    “The proposal shall not include 

     

    any recommendation to ration health care”

    • No, actually, while I could conceive of them becoming some kind of “too old…next….to sick….next….treatment too costly…next”  I was specifically using them in reference to the argument about patient privacy between the patient and his chosen physician or specialist  – These Home Health teams are responsible for reports to the secretary, pretty much unspecified what can be demanded for reporting… to say it’s vague would be a kindness.
      “(e) REPORTING TO SECRETARY.—An entity that receives a grant or contract under subsection (a) shall submit to the Secretary a report that describes and evaluates, as requested by the Secretary, the activities carried out by the entity under subsection (c).
      (What does “as requested by the Secretary” mean?  That Abortion still ‘private’ if Mr or MS Dr has contracted with one of the managed care home team?)”
      Neo’s concern was “with ObamaCare’s the government’s “Medical Advisory Board” now able to make some health care decisions for you, does this undermine Roe v Wade’s “privacy” underpinnings,”
       
      So, part of his concern was privacy….now, the Medical Advisory Board didn’t appear to be an issue, as you said, that’s not it’s function….
       
      Here’s the lead in to my original post on it –
      looker:
      March 23, 2010 at 14:00
      Yeah, well, before you two dance in the aisles about the privacy issue not being a concern for your Medicare advisory board, why don’t you check out –
      SEC. 3502. ESTABLISHING COMMUNITY HEALTH TEAMS TO
      SUPPORT THE PATIENT-CENTERED MEDICAL HOME.”
       
      And while I know you’re hung up on the Medicare portions, it’s NOT under the Medicare provisions or control….unless this whole bill is now to be considered ‘Medicare’.  It’s part of the new system – apart from, but cooperating with, Medicare providers.
       
      I suggest you read it again too.
       
      By the way Cap, how’s your BMI?  Are you Chronically overweight?  Might want to entertain yourself by reading that section….Everyone I’ve spoken too here in the office is considered chronically overweight according to the new Government BMI number – and I can guarantee in one case, that’s insane.  But hey, it’s the law now, and NOW the government can DO something about all us fatties (I’m not really ya know, but according to them, the extra 3 lbs I need to lose to be NOT Chronically overweight is a CHRONIC problem).

      • Clarification the “them’ that I can see becoming a “too old…next….” is the Home Health Care teams that consult with providers.
         
        It’s inevitable dude, there is only so much care available, only so many hours in a day, only so many dialysis machines in a treatment center.  Government, and I mean that now in EVERY sense of the word, WILL ration Health Care.  To think otherwise is just naive (and since it’s already happening under private care, why do you think the Government can do it better and NEVER ration it?….did you see the Post Office is going to drop Saturday delivery because it costs too much?   Just asking….seems like it has nothing to do with medical care doesn’t it….)

        • “seems like it has nothing to do with medical care doesn’t it….”
           
          Last Saturday, it didn’t.  Today, not so much.

  • The Reporting to the Secretary element would have to conform to the privacy provisions of the bill:

    ‘‘(e) PROTECTION AND SHARING OF DATA.— ‘‘(1) PRIVACY AND OTHER SAFEGUARDS

    “.—The Secretary shall ensure (through the promulgation of regulations or otherwise) that—‘‘(A) all data collected pursuant to subsection (a) is protected—‘‘(i) under privacy protections that are at least as broad as those that the Secretary applies to other health data under the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996″

    • Protected against WHO Cap?    The Government?   Your information isn’t protected against the Government, it’s your history, it’s your National Health Care.
       
      Christ you have an agency that wants to know how many flush toilets you have in your house on the premise that they can Constitutionally gather it as part of CENSUS data.  And you think your private health issues are safe?