* The so-called "Patient Care" bill, HR 3590

Anti (little 'd') democratic:

The public opposed the bill 54 to 41 ( href="http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/september_2009/health_care_reform"
id="em6e" title="Rasmussen poll of 3/20">Rasmussen poll of 3/20).
The Democrats are supposed to be about letting the majority speak
(especially after the 2000 election they argued this). Now, we see
they are not about letting the voter speak, but about pushing through
their agenda regardless. Sure, politics is about using your power to
push your agenda, but the appeals to a more participatory democracy are
clearly not serious.

Obama's 3/20 speech to
Democrats (on C-SPAN) extolled them to do the right thing despite
political pressures in their district. In other words, ignore the will
of the voters and act like dictators. I thought it was Democrats who
were all about representing the people?

Payoffs: Not only did the
public not want it, Congress did not want it either. The thin margin
of passage was gained by paying off particular representatives, (e.g. href="http://www.cbsnews.com/8301-503544_162-6006838-503544.html"
id="jr.e" title=""Louisiana purchase"">"Louisiana purchase", href="http://www.californiawatch.org/watchblog/delta-democrat-denies-swapping-health-care-vote-irrigation-water"
id="qu3d" title="California water rights">California water rights,
others[ href="http://www.cbsnews.com/stories/2010/03/19/eveningnews/main6315581.shtml?tag=contentMain;contentBody"
id="bpp0" title="CBS">CBS] ). It's doubly ironic because
Democrats want "money out of politics" when it comes to campaigns, but
not when it comes to buying their own legislative agenda from other
legislators.

"The
Senate will consider it under a parliamentary maneuver that will allow
the Democrats to pass it with a simple majority, averting the threat of
a Republican href="http://topics.nytimes.com/top/reference/timestopics/subjects/f/filibusters_and_debate_curbs/index.html?inline=nyt-classifier"
title="More articles about filibusters and debate curbs.">filibuster.

" i.e. the Democrats are going to violate the rules of the
reconciliation process to get it ( href="http://www.nytimes.com/2010/03/22/health/policy/22health.html?src=me&ref=health"
id="medz" title="NYT">NYT^{href="http://docs.google.com/a/kelvinist.com/Doc?docid=0AWg9p11BBf8cZGNiNnY5ajRfNmdudnJ2ZmY5&hl=en#FOOTNOTE-1">1} ).

Electoral deception:

"Must issue" kicks in Jan 2014,
just after the election. Obama didn't want you to see the price
increases that will cause before the election.

"You can keep your existing
insurance". Not really. Existing policies are exempted from some of
the requirements (sec. 1251). But new policies cannot be offered like
old ones. Thus, over time, as employees change jobs and companies come
and go, the market for your current policy will be ratcheted down until
the insurance company no longer offers it. Your current policy has
been de facto outlawed. It just won't happen before the next
election. More subtly, insurance companies will have to charge more
for new plans, but rates are now partially price-controlled (1003
(b)(1)(B)). If insurance companies are forced to raise the cost of
existing plans to cover new, more expansive, plans, your existing plan
has been de facto outlawed by being forced into an uncompetitive price
position.

Obama promised no new taxes on
people earning < $250K. This bill is paid for mostly be taxes on
exactly such people, albeit hidden in price increases as excise taxes
on medical provision.

Rent Seeking and innovation

It's loaded with new regulations about when and where you can
offer any service. It's now more valuable to lobby Congress to have
your equipment/procedure approved than it is to invest in innovation.

It's paid for in part with a 4% tax on capital gains, further
crippling the investment market on top of other cap gains increases
Obama has planned ( href="http://www.heritage.org/Research/Reports/2010/03/Obamas-Capital-Gains-Tax-Hike-Unlikely-to-Increase-Revenues"
id="gxlp" title="Heritage analysis">Heritage analysis) [ for my
fellow Facebook employees, you just lost 4% of your stock value with
this single bill ].

"Moral Hazard" will lead to higher cost

One of the main drivers of medical cost inflation is being
over-insured, making it artificially cheap to consume more medical care
than makes financial sense. This bill moves the wrong way, away from
individual insurance and toward employer insurance, making the problem
worse as there in less incentive to shop for insurance.

It forces coverage of many things that are not necessarily
insured now (e.g. mental health care, drug rehab, maternity, pediatric
dentistry, section 1302). That is, you will be forced to cross
subsidize things you'll never need, but the people who do will now see
neither out-of-pocket cost nor (appropriately) higher premiums, thus
insulating their cost and pushing over consumption.

It caps deductibles ( href="http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR03590:TOM:/bss/d111query.html"
id="coij" title="section 1302 (c) (2) (A)">section 1302 (c) (2) (A)),

which limits the ability of the insured to spend health dollars
effectively (while still having a catastrophic care policy) and instead
puts more control in the insurance companies' hands and leads to more
cost increases with less efficient spending.

See for example: href="http://www.rand.org/pubs/reports/2006/R3729.pdf" id="l-_2"
title="Rand study">Rand study, also reported in href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V8K-3VWC6KY-4&_user=10&_coverDate=10%2F31%2F1996&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0e236a2286fc6beb752e14dd0138373c"
id="zgdc" title="Journal of Health Economics 15(5) 10/96">Journal of
Health Economics 15(5) 10/96 finding the optimal co-insurance rate
to be 50%, title="MIT Finkelstein study">MIT Finkelstein study showing
Medicare contributed to cost inflation.

Phony accounting:

Contrary to Democrats' claims, it expands the deficit. The CBO
neutral scoring was because the Democrats gamed the rules the CBO
operates by. For instance, it draws revenues for 10 years but only
pays for 6 years, it transfers money from Social Security without
funding the shortfall there (NYT editorial 3/20/10, previous href="http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html"
id="wb:q" title="CBO director DOUGLAS HOLTZ-EAKIN">CBO director
DOUGLAS HOLTZ-EAKIN ). This is especially relevant because some
"blue dog" Democrats changed their vote based on it being deficit
neutral. Thus, the bill passed because of deceitful accounting.

To be deficit neutral it assumes that medical care costs will
decline ( href="http://gregmankiw.blogspot.com/2010/03/caveats-from-cbo.html"
id="rium" title="Mankiw referencing CBO">Mankiw referencing CBO 3/21/10)

by, for instance, continuing to cut Medicare payments to doctors. CBO:
" It is unclear whether such a reduction in the growth rate of spending
could be achieved, and if so, whether it would be accomplished through
greater efficiencies in the delivery of health care or through
reductions in access to care or the quality of care face="arial,helvetica,sans-serif">." Even the CBO is
calling Democrats liars.

Assumes nothing will change, e.g. Cadillac tax assumes that
won't discourage such plans and thus generate lower revenue ( href="http://www.cato-at-liberty.org/2010/03/21/its-not-a-health-bill-not-a-medicare-tax-and-it-cant-possibly-cost-only-940-billion/"
id="xczv" title="Cato">Cato). Similarly, it assumes that taxing
cosmetic surgery won't discourage such spending.

Capricious taxation

It's a sick tax, it taxes doctors, drug companies, equipment
manufacturers, and insurance. The sicker you are, the more your taxes
just went up to cover other people. Why should welfare be paid by the
sickest?

Tanning salons and cosmetic surgery are taxed as special
cases. It's tyranny of the majority taxation of a minority,
outrageous. Imagine the outrage of taxing fade cream instead of
tanning salons. Cosmetic surgery is one area where prices are falling,
in part because it is not over regulated and not handled via
insurance. It's hardly surprising the government wants to cripple the
industry that demonstrates the fallacy of socializing care, when that's
just what this bill does.

Silencing critics:

Henry Waxman, as committee chair, is threatening companies,
e.g. AT&T, who refuse to participate in the Democratic fantasy of
cost savings and instead honestly report (as they are required to do by
law) the financial impact of this new legislation ( href="http://www.washingtonexaminer.com/politics/Democrats-threaten-companies-hit-hard-by-health-care-bill-89347127.html"
id="x601" title="Washington Examiner, 3/28/10">Washington Examiner,
3/28/10). Waxman: "[you must appear before Congress since] your
company announced that provisions in the law could adversely affect
your ability to provide health insurance. [...] The new law is
designed to expand coverage and bring down costs, so your assertions
are a matter of concern. They also appear to conflict with
independent analyses. " ( href="http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1944:energy-a-commerce-subcommittee-to-hold-hearing-on-impact-of-health-care-reform-law-on-large-employers&catid=122:media-advisories&Itemid=55"
id="jor6" title="Energy and Commerce committee">Energy and Commerce
committee 3/26/10).

* The so-called "Patient Care" bill, HR 3590

Topics: Health
05 Apr 2010

From: Ervan Darnell

* The so-called "Patient Care" bill, HR 3590

Topics: Health05 Apr 2010

From: Ervan Darnell

Topics: Health
05 Apr 2010