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Wednesday, July 22, 2009

"Above All, Do No Harm"

Most Americans are familiar with the concept of the Hippocratic Oath, the Oath which our doctors take to commit themselves to the well being and health of those they treat, "Above all, do no harm." This is not the oath taken by members of the United States Congress nor the President of the United States. Their oaths are to preserve, protect and defend the Constitution of the United States. To preserve, protect and defend the Constitution, sometimes you must do harm. This must be the guiding force for President Obama and some Democrats in Congress as they are pushing for passage of a Health Care Bill that will dramatically alter the United States health care systems, economy and culture. And it must be done by August because members of Congress go on vacation for the month.

So far the 111th Congress has passed, and President Obama has signed, some pretty significant legislation that was bulky, expensive beyond historical proportions, and unread. As we saw with the "Stimulus" bill passed early in this session of Congress, billions of dollars were spent on projects that almost no members of Congress knew about--except those shoving in their pet projects. The resulting bill did not resemble in spirit or in actuality the intentions given to the American people: to provide Federal funding for infrastructure projects that are "shovel ready" that will provide jobs for Americans. Since passed little of the money has been spent, projects across the country that were "shovel ready" are now on holding pending several additional layers of red-tape, and unemployment is approaching 10%. Last month the House passed the Cap and Trade Bill which is very harmful to American businesses and is very expensive, and went unread by almost every member of the House before they pushed it through with a bare majority vote--needing eight Republicans to cross the aisle for passage.

In 1993 then First Lady Hillary Clinton presented a health care reform package to Congress that was over 1000 pages and very complicated. Members of Congress read the bill, found many flaws and eventually decided it was not something their constituents wanted. In 2009 Democrats presented a health care reform package to Congress that is over 1000 pages and very complicated. Members of Congress are barely reading the bill and are expected by Congressional leadership and the President to pass it in the next week. One can hope that the 111th Congress will follow the lead of the 103rd Congress and actually read and deliberate the bill before them. Given the rushing to vote on major bills thus far my hope is scant.

Health care in America is very complicated with many layers, there is private insurance, Medicare, Medicaid, Medical, COBRA, medical groups, HMOs, PPOs, and all you want is to have your child vaccinated or treated for bronchitis. Most Americans are in good health, have minimal interaction with the medical profession, have good insurance obtained through their place of employment and seeing rising premiums despite their good health because of government regulations that say premiums cannot be higher for one employee than another. So at work you pay higher premiums for the poor health choices of co-workers who may have issues due to their over-eating, smoking, drinking, etc. As well you pay additional taxes to pay into Medicare and Medicaid/Cal to pay for the health care of those who do not have insurance, they are covered at very little or no cost whenever they visit the doctor or a hospital. Most Americans are not thrilled by their higher taxes and premiums due to the poor decisions of their co-workers and the uninsured they are covering, but they pay and move on.

From an employer standpoint health care is very complicated as well. Regulations state that how one is covered all are covered. Many companies have one or more people dedicated just to managing the health insurance and other benefits provided to their employees. In America if you own a company you are also responsible for your employees health care, why is another topic, but personal responsibility for one's health care has been taken from you the individual and given to your employer. Thus your employer selects which insurance company will provide your insurance and which plans will be available to you. As mentioned because it is a group plan your premiums are predicated on the overall health of the group, lowest common denominator dictating premiums for the most healthy. The employer must keep track of the premiums, ensure the insurance company is helping employees, keep track of when new employees are eligible and keep track of the COBRA rules for employees whose employment is terminated either voluntarily or involuntarily. Most employers take on this burden as a cost of doing business and understand to be competitive in the marketplace for quality employees must have a good insurance plan. Some employers pay all the premium for a worker and his/her family, others cover just the employee's portion, but whatever is covered for one must be covered for all.

Under the bill currently being rushed to vote in Congress for health care reform are provisions that many employers will welcome from a profit standpoint, while probably dislike from a personal standpoint. In the bill companies will be able to drop their company insurance plans and save money on their health care costs. Depending on the total payroll of the company, any company not providing insurance for their employees will have to pay from two to eight percent of the payroll to the government who will provide their insurance. So no more COBRA, no more keeping track of premiums, no more having personnel specifically on the payroll just to deal with insurance. Further for many companies paying even an 8% additional payroll tax is cheaper than the premiums they are paying now for their employees. Further, in the plan is a provision to tax the health care premiums that are paid by the employer and the employee--no more pre-tax benefit for health insurance. By getting rid of the insurance plan the employer saves money in premiums, labor resources and costs to track insurance and payroll taxes. Simple math and a look at the bottom line dictates getting rid of the company plan. Suddenly you are federally insured and subject to the guidelines, policies and procedures for your healthcare as dictated by the federal government.

President Obama has said that if you are in a private insurance plan and have a family doctor you will not see any changes or additional cost because of the bill in Congress. This is simply not true. There is no way this plan with costs in the trillions, which will alter the relationships, compensations, premiums and requirements for employers, doctors, hospitals, pharmacies, drug companies and patients will not impact the status quo. Further at a cost of several trillion dollars who is going to pay for this? The "rich"? Guess who becomes "rich" once the government needs to pay a bill that has now grown to over $12 trillion before this health care bill?

If you own a company you must contact your Congressional representatives and tell him/her you will support their re-election if they rush to vote on this bill before it can be dissected and debated. If you are insured by your company you must contract your Congressional representatives and tell him/her you will not support their re-election if they rush to vote on this bill. No one wins by Congress taking the most complicated issue before our country, its health and health care delivery, and "solves" the issue in less than two or three weeks.

Obama repeatedly said on the campaign trail that he wanted bi-partisan support for major issues, that he would change politics in Washington and reach across the aisle for input and ideas in crafting solutions to such major issues as health care. Well we have seen that for him bi-partisanship is Republicans agreeing with him, bi-partisanship is presenting one solution across the aisle and criticizing and debate, bi-partisanship is shutting the opposition out of meetings where legislation is being crafted. This issue is too big to shove through Congress. It impacts every single American, except those in Congress with their own health care system. It impacts every person reading this post. Contact your Congressional representatives and tell them to slow down. Read the provisions, speak to your constituents and do what they want.

When dealing with health care one should remember, "Above all, do no harm."

UPDATE 7-22-09 1:00 pm: Thanks to sister Sharon for providing this link which contains a list of "tweets" from blogger at Economic Policy Journal who has read the 1000 page bill and posts his findings. A sample: "PG 203 Line 14-15 HC - "The tax imposed under this section shall not be treated as tax"" and "PG 50 Section 152 in HC bill - HC will be provided 2 ALL non US citizens, illegal or otherwise" and "Pg 425 Lines 17-19 Govt will instruct & consult regarding living wills, durable powers of atty. Mandatory!" Read the entire list put together so far at EconomicPolicyJournal, real policy lifted right out of the bill Obama is pushing to have passed by August 1st.



Bob Schilling said...

Let me offer a few responses to your post --

You, like many conservatives, seem to have misunderstood the nature of the "Stimulus Program." Most of the money in the program was RELIEF money -- funds for the extension of unemployment payments, funding to help states make medical payments for programs such as MediCal, and funding to subsidize medical insurance for the unemployed. I assume that the last category helped offset COBRA payments. Only now are the public works elements of the Stimulus Program starting to take effect. Even "shovel ready" programs have to be contracted, and that takes time. The Stimulus Program did not suspend federal, state or local contracting procedures. Thank goodness. Evaluate the "stimulus" part of this program next spring, when we'll start to see funding really flow.

As a pragmatic liberal, I feel disadvantaged by the fact that I haven't read the bill, either. Then again, there really ISN'T a bill yet. There's a committee report from the House, and the Senate is working on options, but there really isn't a final form. What we do have are competing claims by special interests, some direct and some delivered by the legislators they support (I'm being polite).

One thing to consider is that many large private corporations and most large public agencies don't actually carry insurance. They are "experience based," meaning that they pay insurance carriers to process claims, and to provide buffer financing to level peaks in expense. Anything that reduces the processing overhead is helpful to them. Insurance companies don't want to lose this business - it's very profitable.

It seems to me that all of this hoo haa isn't going to changes things much for people who now have insurance. There might be a marginal reduction in premiums, but I'm not holding my breath. We may all have to pay more to insure the indigent and those who aren't covered by their employers, but that's not going to revolutionize anything. We can probably make it up by appealing our property tax assessments.

As for bipartisanship, it seems to me that the Republicans have pretty much abandoned it. The seem to be willing to join Democrats ONLY where their views are accepted without question. That's not bipartisanship -- it's obstruction. Jim DeMint seems to best personify the attitude -- "let's use health care to wreck Obama's presidency." Speaking of "do no harm....."

Dennis C Smith said...

Bob: You have me cracking up I have to admit. So the purpose of the stimulus program is now to have aided the unemployed? Didn't Obama say it would lower unemployment so it would not reach 8%? (Yes). Did he not say the purpose was to create jobs? (Yes). It's not what conservatives are saying it is what Obama said!

As for the health care bill, it most certainly will have a negative impact on the privately insured as the purpose of the bill is becoming increasingly clear: to eliminate private insurance and put the Feds into control of all health care. Do you really want the Feds poking into your family trust and DNR clauses?

Finally, whenever any Democrat, Independent or non-Republican speaks about Republicans blocking legislation or being non-partisan I about wet myself. Look at Congress from 2001 through 2008, what about Federal judicial appointments that never got an up/down vote? What about social security reform? Everything that Bush or GOP proposed was not met with anything but "No." At least Bush started his presidency trying bi-partisanship--remember No Child Left Behind? A mistake from my point of view as it expanded the role of the government, but it was co-authored by Kennedy. He got near unanimous support from Congress for taking out Sadaam. Then politics came into play, George Soros and the left started squeezing and the Dems fell over themselves to put Pelosi in their driver's seat. Good-bye any chance for bi-partisanship.

Demos locked the GOP out of the stimulus legislation talks, locked them out of the Cap and Trade legislation talks and have locked them out when they crafted the abortion (will be funded by federal dollars) of a health care bill.

Thankfully Obama and Pelosi have veered so far against the culture of Congress and to the left that many Democrats are realizing what is going on and are opposing this legislation and Cap and Trade. Obama and Pelosi are spending political capital as fast as they are spending fiscal capital and our tax dollars.

The health care package currently on the hill must die or it will kill Americans fiscally and perhaps really with mandated health care decisions by your local federal health care administrator.

Thanks for the chuckle!