Sunday, August 2, 2009

The Most Boring Reading in America Today: "America's Affordable Health Choices Act of 2009"

After getting incredibly tired of receiving emails and Facebook postings about how my life is going to come to an end if the health care legislation currently before the House passes, I realized that I needed to look into the issue and decide if all the apocalyptic rhetoric was founded. So, yesterday I spent the day reading the 1000+ pages of the legislation. This is not as impressive as it sounds, because it's not 1000 full pages. Most of the pages have, maybe, a paragraph of information. In fact, if they submitted this legislation to a high school English teacher, they would most certainly be busted for using large margins and large fonts to increase the size. On the flip side, it was hardly compelling reading. In fact, I now have a new definition for boring reading: any book, article or essay that invokes a feeling similar to the one which one feels as he or she reads the health care legislation.

I am going to write three blog entries based upon my reading. This first one, a second one detailing the reasons why I believe this health care plan will fail, and one on what I believe to be the Christian response to this legislation (which, no does not involve nominating Sarah Palin for the next presidential election).

I fully admit that I did not understand everything in the bill, as they, being politicians, used as much legalise as possible. However, I was able to understand the bulk of what I read. I also fully admit that I am not an expert at politics, civics, or predicting the future. I am, however, a fairly intelligent person who is able to read and comprehend. I have a solid faith in God's promise to meet my needs, and a belief that our country has made stupid decisions in the past and survived, so at this point don't believe that this here legislation marks the end of it all. Even if it does, I'm not very nonplussed by all this because my citizenship is actually elsewhere, and I'm just serving here until I can get there. I'm aware that He's coming back for me, and it will all be very good then.

I decided to read the legislation because I simply will not base my thinking on reading articles that are written by people who profit from creating panic and fear in the American public. The reality of the press is that the more sensational they make things, the higher the ratings and money. This is especially true of cable television media. I believe that each person is able to think on their own and does not need someone to filter and spin the legislation. And, if we don't, as engaged citizens, actually understand and discuss the legislation, but instead just make blanket statements about all universal health care plans, then we are failing to not only be salt and light, but we are forgoing our opportunity to shape society. There is going to be change in health care. The national push for it in our democracy is too great for nothing to happen. All the polls I've read had indicated that over 85% of all Americans believe something needs to change. If all we do is dig in our heals and refuse to dialogue about the change, then we will end up with no say in the matter. Like it or not, conservatives are the minority right now, and currently have a most disagreeable reputation (thanks to the likes of people such as Sarah Palin, Dick Cheney and Glen Beck). The more we react rather than engage, the less likely we are to have an effect. If however, we behave intelligently, find good candidates and stop ranting, then we have a chance to positively effect our country.

First and foremost, what is the general plan? New health care regulations are the start, and I will only detail a few. I'll say from the start, that this section of the bill, in my opinion, is good. The insurance industry needs regulation and over sight. I don't see how it can happen unless it's does on a federal level. Some of the regulations are as follows: Private Insurance companies will not be able to refuse to renew coverage on a person who has been diagnosed with a medical issue. Insurance companies will not be able to charge exorbitant amounts to people in higher risk pools. They will, however, be allowed to charge higher premiums. Also, people will have the option to "carry" their policies with them when they leave a job by paying into a pool that is not just based within their own company. When a person is denied a claim, the appeal process through the company will be the same appeal process that is used at every other insurance company.

As things stand right now, if someone loses their job, they lose their insurance. I know for our family, that is the most difficult issue we face if my husband is laid off in November. We both have chronic conditions, and if something doesn't change, I'm certain that I will NOT be able to get any decent health care coverage. This is a common problem. I know a family where the husband left his job as he was called to serve in Iraq. They lost their private insurance, and went onto the military's plan. When his service ended, they lost the insurance. In the meantime, their son was diagnosed with a condition that Anthem illogically considered a very high risk. Because of that diagnosis, they were unable to get insurance for their family without paying over $800 a month, in conjunction with what the employer was paying. This is the type of situation that not only punishes a family for doing something they had to do, but holds people back from leaving a larger company to start their own business.

Another fallacy about the legislation that I cannot understand is how people keep referring to this as a "single payer system". What I read was not a single payer system. Forced to somewhat change its structure, private insurance would continue. Instead, there would be options from which a person can choose to purchase, either individually or in conjunction with their employer, into a plan. The difference would be that there would be a public option -- a government run health insurance plan-- that people could also chose to purchase. There is about 200 pages of legislation limiting the scope of the plan, providing oversight and accountability to keep it competitive, if not quite as comprehensive, with private insurance. Considering the overwhelming success of such government systems as say, Social Security, I don't see much concern for the popularity of this plan causing the private insurances to be pushed out of business. And, that hasn't been the case in other nations where both a public and private insurance exist. I'm not saying I agree with this plan, but, again, if there is to be dialogue, people need to understand and speak realistically about what the legislation is.

Another point that has been misrepresented is end of life issues. I have read in multiple articles and listened to multiple talk-show people (who do greatly entertain me when I'm at the Y), that this plan will be coercive to people at the end of life. The myth is that there will be mandatory counseling sessions every 5 years after a certain age, and every couple years if one is in certain risk categories. Again, this simply not true. What is true is that the public option will pay for a patient to see their doctor to discuss end-of-life care (like: Do I want to go to hospice? Should I have a living will? What are my nursing home options?). Under the public option a person may visit their primary care physician up to 1 time every 5 years, unless a patient is at higher risk for needing those services, in which case they may consult every 2 years. There is no wording that makes that mandatory. Anyone who thinks this concept is new, is just simply wrong. Patients have been consulting with doctors for years on these issues, and all this legislation does is guarantee that the public option will pay for one of those consultations. My current insurance pays for a pap smear once a year. The gynecological police do not show up at my house and force me to and have a pelvic exam if I miss. That's a good thing, because gynecological police would be very scary. If I choose not to go, then I, unwisely, choose not to go. Patients across America are routinely discussing end-of-life-issues with their physicians even as I write (okay, maybe not right now because of the time of day I'm writing....), whether someone is coerced into hospice or any other situation will completely depend upon the integrity of the doctor.

Abortion is another thing that has been grossly misrepresented as well, both for sides of the abortion debate. Some people are saying it will limit funding for abortion. Not True. Some are saying it will increase funding. Again, not really true, although maybe a tiny bit true. The legislation does not mandate coverage of abortion. In fact, the writing specifically covers the right of private insurance NOT to cover abortion. In the case of the public option, it offers that abortion will only be covered in cases of rape and incest or life endangerment, which is how it is currently funded under Medicaid.

One final point that people have overlooked as well is this: There is an 18 month research period before any changes become final. Thus, if people will engage in dialogue (again, not rant: engage), then there is the opportunity to make changes in this system to come up with something that will actually work. Keeping in mind that if people behave themselves, congress could look very different in 18 months.


Chris Blair said...

Deb -- I appreciate you taking the time to read through this. I've downloaded it, but have not had time (or sufficient desire) to dig in yet. Uggh.

A couple of thoughts hit me as I read your assessment.

1. Single Payer is not a part of this legislation. However, it is not a secret that the authors and our President aspire to this. It's reasonable to assume that there is a strategy leading in that direction. I think this legislation is the foot in the door.

2. I think that end of life, abortion and other moral issues come into play more-so when (not if) single payer comes into play. I'm heartened to hear that they have placed limitations on abortion. However this will certainly evolve. The authors and president have a clear position in that regard.

The biggest red lights to me are the massive push and the unwillingness to adequately connect the dots between what the problems are and how this legislation proposes to fix the problems.

BTW -- I keep hearing about Obama's plan -- have you seen this plan anywhere? I realize that the legislation is what matters, but Obama is selling his plan. How does this legislation match up?

This is so fundamental that it deserves time for debate and honest dialog. I'd love to see a book outlining the plan / proposed solutions, similar to what the Fair Tax people have done.

The approach the administration is taking is that we have to rush this through before the people wise up and elect people to kill it. If that's the case, and I'm sure it is, then I think that is evidence that this deserves more time and attention.

Thanks for working to keep us at the table :-)


Deb said...


I think that to say that the President and the authors of the legislation aspire to a single payer system is too extreme. First of all, not all democrats are touting a single payer system, secondly I can find nothing where Obama says that he is trying for a single payer system. I have found A LOT of quotes taken out of context to push that idea, but when I've found a context for the quotes, it's been him saying that he likes the idea of a single payer but realizes it's not a practical model because so many people are employed by the insurance industry. Sure, it could happen, just like people who say that making abortion illegal can lead to making birth control illegal. I don't agree with him, single payer is ludicrous, but I still think that the press has created a panic that is not necessary and distracts from the actual flaws that will convince people to put pressure on legislators to vote this down.

In fact, the single payer community (like a lobbying group called "Physicians for a National Health Care Program") are ticked with him because they say he's told them single payer is off the table. They are also ticked because of whom he tapped to lead his health care reform leadership team.

This is from the PNHP website (I can't get the link to work, ie: I'm not as cool with computers as you are!):

"Dr. David Himmelstein is a founder and spokesperson for Physicians for a National Health Program.
"Himmelstein’s take - Obama is caving to the insurance industry.

“The President once acknowledged that single payer reform was the best option, but now he’s caving in to corporate healthcare interests and completely shutting out advocates of single payer reform,” Himmelstein said. “The majority of Americans favor single payer, and it’s the most popular reform option among doctors and health economists, but no single payer supporter has been invited to participate in the administration’s health care summit. Meanwhile, he’s appointed as his health reform czar Nancy-Ann DeParle, a woman who has made her living advising health care investors and sits on the board of many for-profit firms that have made billions from Medicare. Her appointment — and the invitation list to the healthcare summit — is a clear signal that the administration plans to propose a corporate-friendly health reform that has no chance of actually solving our health care crisis.”

As I pointed out in one of my entries, if we discuss what's on the table and not engage in rhetoric about what might happen, I think we're going to go further to bring about change in this legislation. In order for Obama and the dems that want single payer to succeed, it will take years and multiple elections. Whether he's changed his position on that because he really thinks it won't work -- I doubt it. I think he realizes it won't fly. His power is limited, as is congress, and to make change that would make millions of Americans (including those left unemployed by the change) unwilling to vote for them.

Honestly, I think that Obama is more concerned with becoming the first president since Lydon Johnson to make sweeping changes in social policy than any said policy.

I believe that Obama's health plan is essentially the one that has been made into the legislation. There has been little change since congress is controlled by democrats. He's calling the legislation his plan. I can't find anything else with the exception of the White House website has a dinky little 3 paragraph thing.

As much as I don't agree with many of his policies, I do like that one of his goals is to make government as transparent as possible, with as much accountability as possible. I saw that part of his plan written into the legislation.

Chris Blair said...

Didn't say that all democrats aspire to Single Payer. Said our president and the authors. I admit that authors may be a bit extreme because I don't know for sure who all is authoring unless this is Obama's plan. Then I have to conclude, based on Obama's own statements in the past, that this is ultimately what he is after.

Assuming it is legit, and I haven't heard anything to suggest that it isn't, this video is pretty clear despite what the White House wants to say about it. I realize this is campaign mode and stands in contrast to what he is saying now. However, I haven't heard him retract this. I maintain that it's reasonable to assume that this legislation is likely a step toward Single Payer. Very possible it's the first step of many that need to occur to get there.

That said, I agree with you about the distraction effect.

Chris Blair said...

OK -- not to beat a dead horse, but I came to my belief that this legislation is a step toward Single Payer without the benefit of this evidence.

Whether or not the strategy works, its clear that advocates of Single Payer believe that a public option is the politically savvy route to get there.

Deb said...


I have no doubt that there are people within the democratic party want single payer, however, the link you posted is too a conservative "think tank" site (the heritage foundation), so I, personally, don't base my thoughts on health care reform based upon their analysis as they have their own agenda. I've tried to stick with primary sources (legislation and speeches in their entirety and within their context) so that I can analyze it myself. I don't trust the integrity of either conservative or liberal political rhetoric.

I do think that Obama would move to a single payer if it were politically and economically viable, which is why when campaigning he said that (to union people who wanted to hear it). Those campaign promises are why the single payer people are so angry with him right now. However, I think that it's all a moot point because that's not the discussion on the table as of right now. So, what happens is people are arguing something that shows they aren't informed, looks hysterical, and does long term credibility damage.

There are enough problems with the legislation to simply argue the legislation. Honestly, I've read several polls lately that shows support for the legislation dropping because of the simple fact that no one believes that we can pay for this legislation. It makes more sense to fight it on the merits of what is actually there.