The alleged text from Judge Kithil starts with the following:
"I have reviewed selected sections of the bill, and find it unbelievable that our Congress, led by Speaker Nancy Pelosi, could come up with a bill loaded with so many wrong headed elements."
My response there is this. I have reviewed "selected sections" of Romeo & Juliet, and I absolutely hated it. Then I read the whole damn thing and realized the context. You cannot review "selected sections" of anything and form such a biased opinion. If you are going to publish this information, take the time to read the whole damned thing.
Some will argue that the bill is 2,000 pages long, how can anyone read it. Well, I ask this. How many pages should it be? How many pages should a health care bill be that goes farther than any legislation in history to insure more Americans than have ever been insured? Would making this bill smaller make people like it better? Sure. Would that also take out important elements just to make it 'easier' to read? Yes.
Judge Kithil goes on to write:
"I am opposed to HB 3200 for a number of reasons.
To start with, it is estimated that a federal bureaucracy of more than 150,000 new employees will be required to administer HB3200. That is an unacceptable expansion of a government that is already too intrusive in our lives. If we are going to hire 150,000 new employees, let's put them to work protecting our borders, fighting the massive drug problem and putting more law enforcement/firefighters out there."
This is absurd. First, "it is estimated" means that it could be a 5 year old making the estimation. There are no facts to back up this estimation. I can estimate right now it will take 5 million people, or I could estimate it will take 5 people. There you go, that's 3 different estimations in less than two paragraphs. Additionally, yes these people could be put to work protecting our border, fighting the massive drug problem or putting more law enforcement/firefighters out there. Those are all legitimate problems that this health care bill is not intended to solve. I can make the reverse argument and say that we can take the people protecting our borders, take the people fighting the massive drug problem and take the law enforcement/firefighters and put them to work on health care, then we wouldn't need the bill. Judge Kithil is using those 3 specific items to create an atmosphere of fear around the health care bill, because each of those is a National Security issue unrelated to health care.
Judge Kithil then cites specific pages and sections of the bill that he has problems with, which I will refute case-by-case below.
** Page 50/section 152: The bill will provide insurance to all non-U.S. residents, even if they are here illegally.
The very first sentence of this section states: "Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act". On page 143, section 246. Titled "NO FEDERAL PAYMENT FOR UNDOCUMENTED" it specifically states: "Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."
I guess if I only read one section of one page of the bill, I too would be pretty scared. Unfortunately, the bill does specifically provide language that prohibits Federal money from subsidizing illegal alien's health care.
** Page 58 and 59: The government will have real-time access to an individual's bank account and will have the authority to make electronic fund transfers from those accounts.
This particular section is called "(4) REQUIREMENTS FOR SPECIFIC STANDARDS." Since Judge Kithil did not elaborate on how he came to this conclusion, I can only assume it refers to section (C) which states, "enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice."
Have you ever had your tax refund direct-deposited into your bank account? Ever write a check to the Registry? Do you have your Comcast, Car payment or other bills automatically withdrawn from your checking account? If so..the government is not gaining any more information than it already has. The provision in this section is designed to force the Federal government to standardize the way it performs electronic transactions. If you do not pay your co-pays electronically now, you don't have to in the future. This does not REQUIRE that the government gets your financial information, it sets up a standard way of processing payments for people who do CHOOSE to perform transactions electronically. I would love it if every time I went to the doctor they could automatically take my co-payment without me having to do anything. There are certainly problems that can arise from this, but trust me...this bill is not going to change whether the government can or cannot access your bank account. It already can do that.
** Page 65/section 164: The plan will be subsidized (by the government) for all union members, union retirees and for community organizations (such as the Association of Community Organizations for Reform Now - ACORN).
This claim is completely baseless. Section 164 allows for a "Reinsurance Program" for retirees or their spouses. This is to reimburse participating employment-based plans for paying out benefits to retirees or their spouses, in cases where the retiree is not yet eligible for Medicare. Section 164 never makes any statement that requires a participating plan to be that of a Union. Any employment-based plan is eligible, and must apply to Health and Human Services. This is one issue where Judge Kithil is using the image of unions and Acorn to inspire fear...
** Page 203/line 14-15: The tax imposed under this section will not be treated as a tax. (How could anybody in their right mind come up with that?)
What Judge Kithil clearly does not identify here, is that these two lines that are quoted are in a section that starts page 197 titled "SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS." The significance of this statement is that Judge Kithil also doesn't include the entire sentence, only those words that seem strange.
‘‘(4) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.—The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.’’
What you might find interesting when you read the entire sentence is that the tax is only not counted as a tax when it comes to determining credits. Basically, when a High-Income person is formulating the amount of tax on their health plan, there are certain provisions that allow them to reduce the amount of tax they pay, based on taxes they've already paid. What this section does, is say you can't use the tax you are paying on your health plan to subtract from the same tax that you are paying on your health plan. If it wasn't for the creative loop-holes that are generally found by these "High Income" individuals, this section probably wouldn't even be needed. This entire section affects less than 5% of the population. Want to know if you will have to pay a tax under this rule? If you make more than $350,000 you will pay 1% of your health plan cost. If you make $500,000 - $1,000,000 you will pay 1.5%, and if you make more than $1,000,000 you will pay 3%. So..how many of you are affected?
** Page 241 and 253: Doctors will all be paid the same regardless of specialty, and the government will set all doctors' fees.
Again, what is frustrating here is that there is nothing letting you know that the contents of Pages 241-253 (and then some) are all SPECIFICALLY RELATED TO MEDICARE PART B. Medicare Part B is the plan that deals with doctor's services. (As an aside, Part A is hospital care, and Part D is prescriptions. I have no idea what Part C is, and have never heard it used).
Anyway, on page 241 the section is clearly titled, "(d) ESTABLISHMENT OF SEPARATE TARGET
GROWTH RATES FOR CATEGORIES OF SERVICES." The title itself explains that this is not for payment of services, but created categories of services to be used when calculating growth rates for the number of times that service is performed. This is used for Medicare to accurately anticipate what it will payout for any particular type of service. On page 253, the bill goes on to specifically state that value units (the amount paid for services) are calcuated based on certain factors, "
(ii) COMPONENTS AND ELEMENTS OF WORK.—The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include validation of the pre, post, and intraservice components of work.
But, most importantly, this is all ONLY RELATED TO MEDICARE PART B, not health coverage in general. Since there will be no government option for health insurance, the government will not be paying any physicians outside of the Medicare plan.
** Page 272. section 1145: Cancer hospital will ration care according to the patient's age.
This is absolutely ridiculous. I will paste the entire section here to show you how outrageous this claim is:
SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:
‘‘(18) AUTHORIZATION OF ADJUSTMENT FOR CANCER HOSPITALS.—
‘‘(A) STUDY.—The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection (as deter- mined appropriate by the Secretary).
‘‘(B) AUTHORIZATION OF ADJUSTMENT.— Insofar as the Secretary determines under sub- paragraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011.’’.
Someone please point out to me where age is any consideration in this section. It's not there, so don't spend too much time looking for it. Section A says that the Secretary of Health and Human Services will perform a study to determine if the same procedures done of Ambulatory patients at a Cancer hospital are more expensive than the at a regular hospital. It only refers to Ambulatory services, not admitted patients. Section B says that, if it is determined that Cancer hospitals cost more for the same procedure, than the Secretary can adjust the amount paid to the Cancer hospitals to be in-line with what other hospitals are being paid. How is that not justified? If you were paying for someone to have a procedure done and they had the choice of going to two different places to have the exact same thing done, but one of those places charged a much higher price, what would you do? Mind you, if you have the money and can afford the nicer place, there is nothing in this bill that would prevent you from going there and paying the higher price yourself.
** Page 317 and 321: The government will impose a prohibition on hospital expansion; however, communities may petition for an exception.
Again, this claim is based in a section of the bill called, "SEC. 1156. LIMITATION ON MEDICARE EXCEPTIONS TO THE PROHIBITION ON CERTAIN PHYSICIAN REFERRALS MADE TO HOSPITALS." ... the specific text that Judge Kithil refers to is titled as such, "(i) REQUIREMENTS TO QUALIFY FOR RURAL PROVIDER AND HOSPITAL OWNERSHIP EXCEPTIONS TO SELF-REFERRAL PROHIBITION."
What does this mean? It means that there are certain rules setup so that a Doctor cannot refer a patient to a hospital that is owned, in-part, by that same Doctor. However, Medicare allows exceptions for hospitals that are in rural areas, where the Doctor may have no choice but to refer a patient to the hospital which they have some ownership in. This section of the bill states that a hospital must re-apply for such an exception if the size of the hospital has changed. As a protection, this makes sense to me. Here is what can happen without this section of the bill:
Dr. Smith sees patient Mike Jones. Dr. Smith refers patient Mike Jones to General Hospital, even though Dr. Smith is part of a physician group that owns the hospital. After essentially referring a patient to a hospital that he own, where care is more expensive, that same hospital starts making facility improvements. Of course, all of this is happening with Medicare's money, since Dr. Smith was paid by Medicare to refer Mike Jones to General Hospital, which was also paid by Medicare. As an owner of the hospital, Dr. Smith stands to make quite a bit of money...so much so, that he can improve his hospital and charge more to the patients that he is referring to the hospital.
Judge Kithil has this in the reverse order. Hospitals that already have an exception will be required to apply for a new one if the size of their hospital is increased or major improvements are made.
** Page 425, line 4-12: The government mandates advance-care planning consultations. Those on Social Security will be required to attend an "end-of-life planning" seminar every five years. (Death counseling.)
This is one of my favorites. This section clearly establishes guidelines for Advance Care planning, in fact, it's even called, "SEC. 1233. ADVANCE CARE PLANNING CONSULTATION."
I have to ask the question. You plan for a baby's birth, you plan birthday parties, weddings, first communions, etc. Why would you not want to plan an event as significant as your death. Additionally, it's not just about your death..it is about the time leading up to it.
If you want, you can pretend that death doesn't happen, but it does. There is no reason in the world not to plan for. The entire section is devoted to consultations to help find resources for health care proxies, advanced directives, living wills, powers of attorney, etc.
I can't understand why anyone would be opposed to having the help of a Doctor (your Doctor, not one provided by the Government) as you approach the end of your life. The mandate also ensures that seniors who are not familiar with the laws regarding these items are not taken advantage of by a family member or strangers who consistently try to take advantage of seniors.
** Page 429, line 13-25: The government will specify which doctors can write an end-of-life order.
This section relates to an ‘order regarding life sustaining treatment’. Certainly, anyone can re-interpret those word to mean 'end-of-life' order, but it simply is not the case. This section sets a standard for the requirements of a 'life sustaining treatment'. The exact text reads:
‘‘(i) is signed and dated by a physician (as de- fined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care.
What that means, is that the Doctor must be acting as a Doctor according to the State law in the state that they are in. I could go out and get my PhD in any number of subjects that are not medical. That does not give me the right to write an order for life sustaining treatment. This section make sure that someone just calling themselves Dr. whatever cannot write such an order.
What you don't get in Judge Kithil's remarks is the rest of this section, but you do get it below:
‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, in- cluding an indication of the treatment and care de- sired by the individual;
‘‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary);
As you can see, this section is not about the Federal government deciding which Doctors can write these orders, it is about setting up standards so that everyone can agree on what these orders mean and everyone can understand them.
Now, if anyone would actually care to read the bill, you can find it here:
http://candicemiller.house.gov/pdf/hr3200.pdf
Please feel free to comment on this, I know that health care is a controversial subject and certainly welcome any criticism you might have of my interpretations.
