The Obama Medical Rationing Bill What It Actually Says

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What does the
bill, HR 3200, short-titled “America’s Affordable Health
Choices Act of 2009,” actually say about major health care
issues? I here pose a few questions in no particular order, citing
relevant passages and offering a brief evaluation after each set
of passages.

This bill is
1017 pages long. It is knee-deep in legalese and references to other
federal regulations and laws. I have only touched pieces of the
bill here. For instance, I have not considered the establishment
of (1) “Health Choices Commissioner” (Section 141); (2)
a “Health Insurance Exchange,” (Section 201), basically
a government run insurance scheme to coordinate all insurance activity;
(3) a Public Health Insurance Option (Section 221); and similar
provisions.

This is the
evaluation of someone who is neither a physician nor a legal professional.
I am citizen, concerned about this bill’s effects on my freedom
as an American. I would rather have used my time in other ways –
but this is too important to ignore.

We may answer
one question up front: How will the government will pay for all
this? Higher taxes, more borrowing, printing money, cutting payments,
or rationing services – there are no other options. We will
all pay for this, enrolled in the government “option”
or not.

(All bold type
within the text of the bill is added for emphasis.)

1. Will
the plan ration medical care?

This is
what the bill says, pages 284–288, SEC. 1151. REDUCING POTENTIALLY
PREVENTABLE HOSPITAL READMISSIONS:

‘(ii)
EXCLUSION OF CERTAIN READMISSIONS. – For purposes of clause
(i), with respect to a hospital, excess readmissions shall
not include readmissions for an applicable condition for which
there are fewer than a minimum number (as determined by the Secretary)
of discharges for such applicable condition for the applicable
period and such hospital.

and, under
“Definitions”:

“(A)
APPLICABLE CONDITION. – The term ‘applicable condition’
means, subject to subparagraph (B), a condition or procedure
selected by the Secretary . . .

and:

“(E)
READMISSION. – The term ‘readmission’ means, in
the case of an individual who is discharged from an applicable
hospital, the admission of the individual to the same or another
applicable hospital within a time period specified by the Secretary
from the date of such discharge.

and:

“(6)
LIMITATIONS ON REVIEW. – There shall be no administrative
or judicial review
under section 1869, section 1878, or otherwise
of – . . .
“(C) the measures of readmissions . . .

EVALUATION
OF THE PASSAGES:

  1. This section
    amends the Social Security Act
  2. The government
    has the power to determine what constitutes an “applicable
    [medical] condition.”
  3. The government
    has the power to determine who is allowed readmission into a hospital.
  4. This determination
    will be made by statistics: when enough people have been discharged
    for the same condition, an individual may be readmitted.
  5. This is
    government rationing, pure, simple, and straight up.
  6. There can
    be no judicial review of decisions made here. The Secretary is
    above the courts.
  7. The plan
    also allows the government to prohibit hospitals from expanding
    without federal permission: page 317–318.

2. Will
the plan punish Americans who try to opt out?

What the
bill says, pages 167–168, section 401, TAX ON INDIVIDUALS WITHOUT
ACCEPTABLE HEALTH CARE COVERAGE:

“(a)
TAX IMPOSED. – In the case of any individual who does not
meet the requirements of subsection (d) at any time during the
taxable year, there is hereby imposed a tax equal to 2.5 percent

of the excess of –
         (1) the
taxpayer’s modified adjusted gross income for the taxable
year, over
         (2) the
amount of gross income specified in section 6012(a)(1) with respect
to the taxpayer. . . .”

EVALUATION
OF THE PASSAGE:

  1. This section
    amends the Internal Revenue Code.
  2. Anyone
    caught without acceptable coverage and not in the government plan
    will pay a special tax.
  3. The IRS
    will be a major enforcement mechanism for the plan.

3. What
constitutes “acceptable” coverage?

Here is
what the bill says, pages 26–30, SEC. 122
, ESSENTIAL BENEFITS
PACKAGE DEFINED:

(a) IN GENERAL.
– In this division, the term “essential benefits package’’
means health benefits coverage, consistent with standards adopted
under section 124 to ensure the provision of quality health care
and financial security . . .

(b) MINIMUM
SERVICES TO BE COVERED. – The items and services described
in this subsection are the following:

  1. Hospitalization.
  2. Outpatient
    hospital and outpatient clinic services . . .
  3. Professional
    services of physicians and other health professionals.
  4. Such services,
    equipment, and supplies incident to the services of a physician’s
    or a health professional’s delivery of care . . .
  5. Prescription
    drugs.
  6. Rehabilitative
    and habilitative services.
  7. Mental
    health and substance use disorder services.
  8. Preventive
    services . . .
  9. Maternity
    care.
  10. Well baby
    and well child care . . .

(c) REQUIREMENTS
RELATING TO COST-SHARING AND MINIMUM ACTUARIAL VALUE . . .

(3) MINIMUM
ACTUARIAL VALUE. –

(A) IN
GENERAL. – The cost-sharing under the essential benefits
package shall be designed to provide a level of coverage that
is designed to provide benefits that are actuarially equivalent
to approximately 70 percent of the full actuarial value of the
benefits provided under the reference benefits package described
in subparagraph (B).

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the rest of the article

August
21, 2009

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