One of the things that keeps you from dropping them in the nearest volcano is that you had to work too hard to get them. You had to cry, you had to scream, you had to sweat, you had to cuss out health care officials, and when that’s all over with, you’ll be willing to put up with a lot more from your kids.

~Barbara Hall, Northern Exposure, Baby Blues, 1994~

                I believe that most Americans are, to coin a phrase, “Beating a dead Horse” when it comes to the current ‘Obamacare’ debate. Both sides claim to posses the whole truth of what’s in the bill but if that were true why did our non-representing representatives waste the first week of their break being the main targets of a ‘Fanny Spank’ uprising by the American people for NOT reading the 1000 + pages of HR 3200?  

                The lovely and gracious Governor Palin made recent headlines with her Facebook page comments claiming that HR 3200 would create a “Death Panel” for what the government proposes to be necessary “end of life” care and counseling. A recent Fact check article explodes this myth. But Governor Palin did get it half right. The Death panel already exists. Who here remembers H.R. 1 (more commonly known as the Recovery and Reinvestment Act, even more commonly known as the Stimulus Bill and aptly dubbed the Porkulus Bill) contains a whopping $1.1 billion to fund the Federal Coordinating Council for Comparative Effectiveness Research.

                If any of my readers has actually read the fine print in the Congressional plans, you’ll find that a lot of cherished aspects of the current system would disappear. It would take a lot of reading, paying close attention to the fine print of the combined versions of the House and senate versions, 2,000 pages of tortured legal language, but you will see a web of restrictions, fines, and mandates that would radically change your health-care coverage. Let’s take a look at a few things you will lose.

                Gone will be the freedom to choose what’s in your plan. By the government requiring that Americans purchase insurance through “qualified” plans offered by health-care “exchanges” that would be set up in each state that takes away competition because the federal government will impose a minimum list of benefits that each plan is required to offer. What that translates to is if you enjoy choosing your own cardiologist or urologist under your company’s Preferred Provider Organization plan (PPO), if your employer rewards your non-smoking, healthy lifestyle with reduced premiums, if you love the bargain Health Savings Account (HSA) that insures you just for the essentials, or if you simply take comfort in the freedom to spend your own money for a policy that covers the newest drugs and diagnostic tests — you may be shocked to learn that you will lose all of those good things under the rules proposed in the two bills that herald a health-care revolution. The government would mandate extremely full, expensive, and highly subsidized coverage — including a lot of benefits people would never pay for with their own money — but deliver it through a highly restrictive, HMO-style plan that will determine what care and tests you can and can’t have. It’s a revolution, all right, but in the wrong direction.

                You will no longer be rewarded for healthy living, or pay your real costs for ANY treatment. This is made possible by some legal term (and idea) called community rating. There are already 11 states that have some form of community rating. You can call this a form of oversimplification  but myself, being based in pure rational thought defines “Community rating” as a system that will require that all patients pay the same rates for their level of coverage regardless of their age or medical condition. Where the train wreck occurs is when you have a pre-existing condition. It is a proven medical and financial fact that Americans with pre-existing conditions need subsidies under any plan, but community rating is a sledge hammer way to bring so-called fairness to health care. Simply put it will force young people, who typically have lower incomes than older workers, to pay far more than their actual cost, and gives older workers, who can afford to pay more, a big discount. All you have to do is add it up. If a 20-year-old, who costs just $800 a year to insure, is forced to pay $2,500, a 62-year-old who costs $7,500 would pay no more than $5,000. This state law already in effect in some states is the #1 major reason so many people have joined the ranks of uninsured.

                Next you would lose the basic freedom to choose high-deductible coverage by eliminating the one part of the market truly driven by consumers spending their own money. That’s what makes a market, and health care needs more of it, not less. Lets take a look at Health Savings Accounts (HSA). Hundreds of companies currently offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan — say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care. By the government requiring a ‘minimum package’, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. All the government would have to do is set extremely low deductibles and just that simple action would end all HSAs. And the really scary part is they can do it after the bills are passed.

                Next is the Presidents claim that you will have the freedom to keep your existing plan. Now that part is true BUT the law divides the insured into two main groups, and those two groups are treated differently with respect to their current plans. The first are employees covered by the Employee Retirement Security Act of 1974. ERISA regulates companies that are self-insured, meaning they pay claims out of their cash flow, and don’t have real insurance. A good example of this is General Electric, a well know BIG BIG contributor to Obama’s campaign. It is currently written that employees covered by ERISA plans will be “grandfathered in.” Under ERISA, the plans can do pretty much what they want because they are exempt and can reward employees for healthy lifestyles even in restrictive states.

                Now before you go and join an ERISA account read on a bit. It states “ERISA employers have a five-year grace period” when they can keep offering plans free from the restrictions of the “qualified” policies offered on the exchanges. But after five years, they would have to offer only approved plans, with the myriad rules I have already mentioned. So for Americans in large corporations, “keeping your own plan” has a strict deadline. In five years, like it or not, you’ll get dumped into the exchange. As we’ll see, it could happen a lot earlier.

                Now allow me to cover the second group of insured. After the legislation passes, all insurers that offer a wide range of plans to these employees will be forced to offer only “qualified” plans to new customers, via the exchanges. The “won’t lose your coverage” still is in effect but hidden in the writing is still a catch. If your company changes the plan in any way, by altering co-pays, deductibles, or even switching coverage for this or that drug, then the employee must drop out and shop through the exchange. Since these plans generally change their policies every year, it’s likely that millions of employees will lose their plans in 12 months.

                Before I end this week’s rant, I want to cover 1 last lost freedom. You will not be able to choose your own doctor. The law is written as a requirement that you shop for your Dr. thru some quaint monstrosity called a “medical home.” Due to its similarities to an already existing farce I will call it ‘HMO lite’. You will be assigned a primary care doctor, and the doctor will control your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists. Similarly, under the proposal, the Doctors guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care under the heading of cost cutting, as were HMO physicians a few year ago. Does anyone even remember the consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America’s health-care cost explosion. Ah a cesspool by any other name still stinks….

                While the bill does not specifically rule out fee-for-service plans as options to be offered through the exchanges, just remember those plans would be barred from charging sick or elderly patients more than young and healthy ones. Not say they would but it is an incentive for people to game the system by staying in the HMO while they’re healthy and switching to fee-for-service when they become seriously ill.

                Is there hope? Oh yeah. The best solution would be to move to a let-freedom-ring regime of high deductibles, no community rating, no standard benefits, and cross-state shopping for bargains (another market-based reform that’s strictly taboo in the bills).For now, we do suffer from flawed health-care system, but it’s better than any in the world.