President Obama has called for a final up or down vote on the Senate health bill. Here is what you need to know:
The Senate bill (H.R. 3590) makes insurance mandatory. The bill requires everyone to enroll in a "qualified" plan, either by getting it at work or purchasing it.
If you are buying your own, it won't matter whether you choose basic, silver, or gold. The benefits are the same and prescribed by government. Gold plans collect more up front and give you a lower co-pay and deductible. Your plan will cost 10-13 percent more than if the bill did not pass, according to the Congressional Budget Office.
If you already get generous coverage through your employer, you will likely be downgraded. The bill puts a 40-percent tax on "Cadillac" plans, after a grace period to discourage employers from providing them. (Senate bill, p. 1,980) About one-fifth of employer- provided plans currently fall into that generous category. The Congressional Budget Office predicts that employers will reduce coverage to avoid the tax or reduce your take-home pay.
When you file your taxes, you must prove you are in a "qualified plan." The bill expands the authority of the Internal Revenue Service to track you down and fine you if you do not comply. (Senate bill, p. 345)
President Obama promises that if you like your health plan and your doctor, you won't have to change. But at a recorded meeting with Republican leaders on Jan. 29, he admitted the bill breaks that promise.
Government officials are given broad authority to dictate how doctors treat privately insured patients. Never before has this been the case except on narrow issues such as drug safety. Qualified plans can contract only with doctors who obey whatever regulations the secretary of Health and Human Services imposes to improve health care "quality." (Senate bill, pp. 148-149) That could cover everything, from heart care to childbirth.
Forget the public option, abortion and the other divisive issues. More important is this transfer of decision-making authority from the doctor at your bedside to the federal government.
Sixty percent of the newly insured are being put into Medicaid, almost doubling the program. To cover others, the bill offers subsidies to single persons earning up to $44,000 and families of four earning up to $88,000, and specifies how much of your pretax income you will be required to spend for a plan.
The Medicaid expansion and subsidies account for the high price of the Senate bill — about $1 trillion over 10 years. Half is paid for with a $500 billion tax hike. The rest is paid for by slashing future Medicare funding by $464 billion. This, at a time when 30 percent more people will be enrolling in Medicare as the baby-boom generation ages. The numbers don't add up. Baby-boomers who have paid into the system their whole working lives will get less care than seniors currently get.
Richard Foster, chief actuary for Medicare, warned in a Dec. 10 letter that the cuts in Medicare payments to hospitals will cause financial distress and may lead institutions to stop accepting Medicare. One branch of the Mayo Clinic did that in December. Where will seniors go when their local hospital no longer takes Medicare?
Despite claims by the president that Medicare benefits won't be reduced, Sec. 4105 of the Senate bill empowers government to modify or eliminate preventive-care services for seniors based on what the U.S. Preventive Services Task Force recommends. (p. 1,189). That is the same task force that provoked outrage by recommending that women ages 40-49 or over 75 no longer get routine mammograms.
The bill also moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward new arrangements such as the "medical home." That is this decade's version of HMO-restrictions on care, like the unpopular gatekeepers of 20 years ago. Medical homes begin with pilot projects, but the secretary of Health and Human Services is authorized to "disseminate this approach rapidly on a national basis," without further congressional approval.
When Medicare started in 1965, the law forbade the federal government from interfering in treatment decisions. Though that protection has been whittled away somewhat, overall doctors have been able to provide patients with state-of-the-art care, resulting in huge improvements in longevity and quality of life. Life expectancy at age 65 has jumped from 79 years to 84 years. Bypass surgery, angioplasty to unclog arteries, hip and knee replacements to compensate for arthritis and cataract surgery have enabled seniors to lead active lives instead of languishing in wheelchairs and nursing homes. Obamacare will undo that progress.
And what justifies these sacrifices by seniors? The bill allocates money to "community organizations" for "adult preparation classes," defined as — lessons in romance, dating, and self-esteem. (Senate bill, p. 612)
Betsy McCaughey, Ph.D., is a former lieutenant governor of New York under Gov. George Pataki, a health policy expert and chairman of the Committee to Reduce Infection, a private, not-for-profit campaign to stop hospital infections by bringing the best research to hospitals, physicians, medical and nursing students and patients on how to prevent infection. She lives in New York City.
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Health-care bill is ill-advised
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