After a few weeks I finally got the Health Care Bill (HR4872) read. Not the “Fix It” bill. This is my breakdown of what is in the bill. The bill is over 2300 pages and very repetitive. In the instances where it repeated itself, almost word for word, I skimmed. The stuff in italics are my thoughts.

The last 300 pages of the bill deal with education. These pages concerning Pell Grants, Federal Stafford Loans, and Unsubsidized Stafford Loans lead me to conclude that the federal government will control the student loan industry.

Feel free to let me know if I missed anything in the bill. Just make sure to point out where (i.e. page number and line) in the bill it is.

· pp. 28-29: Annual Limitations

· pp. 29-30: Health Benefits Advisory Committee established. The members are to be appointed by the President of the United States.

· pp.37: “Uniform Marketing Standards” (Sounds like price fixing.)

· pp. 41: Independent agency created within the executive branch of the federal government called the Health choices Administration, which will be headed by the Health Choices Commissioner who is to be appointed by the President.

· pp. 102: Automatic enrollment of individuals into Medicaid.

· pp. 107: Special Inspector General appointed by the President

· pp. 109: Set up of a trust fund—There are several of these throughout the bill

· pp. 110: Tax on individuals who do not have adequate health insurance—The Secretary of Health & Human Services determines what adequate insurance is.

o Tax on businesses that do not provide adequate coverage

o Excise tax on those who fail to meet certain health coverage requirements

· pp. 111: States wishing to have their own insurance exchanges need approval from the Commissioner, who can also rescind his approval at any time.

· pp. 116: First mention of the Public Health Option.—Basically this is the government run insurance option.

· pp. 141: reporting significant changes in income

· pp.143: Employer responsibility—Must provide or contribute to health coverage

· pp. 162: Enforcement of Health Coverage participation requirements—Civil penalties on those who do not comply

· pp. 164 line 23: Coordination with excise tax

· pp. 167: tax on Individuals without acceptable healthcare coverage

· pp.197: Surcharge on high income individuals.

· pp. 289 line 11: Reducing Medicare payments to hospitals with readmissions.

· pp. 338: Secretary (of Health & Human Services) allowed to use audits to ensire compliance from hospitals

· pp.339 line 16-24: “INSTITUTE OF MEDICINE STUDY OF GEOGRAPHIC ADJUSTMENT FACTORS UNDER MEDICARE. IN GENERAL.—The Secretary of Health and Human Services shall enter into a contract with the Institute of Medicine of the National Academy of Science to conduct a comprehensive empirical study, and provide recommendations as appropriate, on the accuracy of the geographic adjustment factors established under sections”

· pp. 343 line 15: study on geographic variation in per capita health care spending among medicare & privately insured populations

· pp. 415 line 9: Grants to Medicare providers and communities with racial & ethnic minorities

o pp. 417 line 13: Community organizers seem to get priority

· pp. 434-440: Advanced Care Planning for all individuals is mandatory. And, yes, the Death Panels are still there. It is called “end of life counseling”, but the fact that this counseling is required concerns me.

· pp. 509 line 19: Advisory Committee on Immunization Practices established. This is a bureaucracy where the members will be chosen by the Secretary of Health and Human Services (always referred to as “the secretary” in the bill).

· pp. 512 line 20: Establishment of Center for Comparative Effectiveness Research—to research how illnesses can be prevented. (read pp.513 lines 8-14)

· pp. 514 line 3: Establishment of Electronic Monitoring of health records & surveillance.

· pp. 519: Civil money penalties imposed on nursing facilities who do not comply with the new federal regulations. (To know all of the new regulations read the part about nursing facilities in the bill.)

· pp. 618: The secretary, Inspector general of the Department of Health and Human Services given authority to set of a “pilot program” to implement an independent monitoring system to oversee interstate & large interstate chains of nursing facilities.

· pp. 631: another bureaucracy set up. The National Priorities Concerning Nursing facilities.

· pp. 646-647: Physicians who receive payment from “applicable manufacturer or distributer” has to submit to the Secretary a form with “respect to the covered recipient,the recipient’s name, business address, physician specialty, and national provider identifier…” and the list goes on.

· pp. 650 line 21: “REPORTING OF OWNERSHIP INTEREST BY PHYSICIANS IN HOSPITALS AND OTHER ENTITIES THAT BILL MEDICARE.”

· pp. 654: Special rules concerning things that are not made public.

· pp. 665: reporting of health care associated infections in hospitals & ambulatory services. (Why does the federal government need to be in charge of this?)

· pp. 671: Distribution of unused residency positions regarding Medicare Graduate Medical Education. The Secretary of Health and Human Services seems to be granted the authority to decide how many residents train at hospitals even for primary care.

· pp. 740: Billing Agents, Clearing House, or other “alternate players” required to register under Medicare

· pp. 840: Fees imposed on insured and self-insured health plans.

· pp. 846: taxes imposed on certain insurance policies.

· pp. 849: Voluntary home visitation for families with young children or expecting children. (Why is the government even talking about home visitations and what is to keep it from becoming mandatory later on?)

· pp. 868: Public Health and Workforce Development (Not sure what this is supposed to be other than another Bureacracy.)

· pp. 894: Awarding of grants to medical students. Preferences is to be given to those in primary care who are minorities, or those serving in areas experiencing “health disparities”, supporting teaching programs that address health care needs of “vulnerable populations”.

· pp. 911: Establishment of a Public Health Workforce Corps. that is supposed to ensure the adequate supply of public health professionals throughout the nation.

· pp. 926: Adapting Workforce to Addressing Health System Needs

o Part 1 is about health professions training for diversity

· pp. 932: Another bureaucracy is set up. The Advisory Committee on Health Workforce Evaluation & Assessment

· pp. 949: Task force on Clinical Prevention Services established

· pp. 956: task Force on Community Prevention Services

· pp. 977: Quality & Surveillance—supposed to ensure quality of medical care

· pp. 985: the Assistant Secretary for Health Information is required to collect data and report on the nation’s health and health care.

· pp. 993: Drug discount for rural and other hospitals. (How we are to pay for that doesn’t seem to be mentioned.)

· pp. 1005: School Based Health Clinics set up.

· pp. 1034 line 19: Public option created to compete with private plans in the Health Insurance Exchange.

o pp. 1036 line 3-6: “shared responsibility among workers, employers, and the government; so that all Americans have coverage of essential health benefits.”

· pp. 1047: Get to keep current plan as long as no changes are made in it & that it was in effect before the bill is in full effect.

· pg 1092: The Secretary will conduct a study to encourage the use of electronic health records.

· pp. 1106: reinsurance program for retirees

· pp.1136: A commissioner specifies benefits to be made available under the insurance exchange.

· pp. 1156: Appointment of a special inspector general for the health insurance exchange.

o this inspector is to be made by the President of the United States without the consent of the Senate.

· pp. 1162: Individual states can apply to the Commissioner to have their own insurance exchange that is separate from the federal one, but they have to have approval from the federal government.

· pp. 1167: Another mention of the Public Health Insurance Option to compete with private plans in these insurance exchanges.

· pp. 1174: Prescription drug rates are to be negotiated with the Secretary of Health and Human Services that are not paid for under Medicare. (This sounds a bit like price controls to keep drug prices artificially low.)

· pp. 1176 line 16-24: The authority of the Secretary of Health and Human Services to set payment rates for physicians not under Medicare cannot be challenged by Judicial or Administrative review.

· pp. 1193 line 1-25: Individuals and families who receive credits for insurance must report to the government any changes in income

· pp. 1199: This is where the section of “Shared responsibility” starts. It appears that under this section employers and individuals are to share the responsibility of making certain that the individual has adequate and affordable health insurance.

· pp. 1212: Civil penalties for employers who fail to meet requirements in providing health care to employees. (This basically makes it mandatory that all employers, whether from big or small businesses, must provide some sort of health insurance to their employees, even if they cannot afford to.)

· pp.1215 line 20-21: Employee tax imposed on employers who do not comply with health coverage requirements. This pertains to the National Health requirements.

· pp.1216 line 4-7: Excise tax on employers who do not comply. This also pertains to the National Health Requirements that are in the bill.

· pp.1224: Tax of 2.5% imposed on individuals without acceptable coverage.

· pp. 1232: Reporting your insurance on tax returns.

· pp. 1237 line 4-13: Penalty of $100 a day for each day an employers fails to meet Health Coverage Requirements.

· pp. 1240 lines 1-8: An excise tax is to imposed on employers who choose not to participate in the Health Coverage Requirements.

· pp. 1253: Surcharge on high income individuals

o 1% on those making between $350,000-$500,000

o 1.5% on those making between $500,000-$1,000,000

o 5.4% on those making $1,000,000 or more

o Taxpayers not filing a joint return will pay:

§ 50% of each dollar amount if married and filing separately

§ 80% of dollar amount in any other case.

· pp. 1369 line 17: Physician Identification Numbers

· pp. 1447: Begins Medicare & language studies & provisions for non-English speakers.

· pp. 1476: Extended months of coverage of drugs for kidney patients. (It is interesting that there is a provision in the bill to extend coverage of drugs for kidney patients. If everything in this bill is supposed to be affordable, then why must there be a provision in here to ensure drug coverage. And not just ensure it, but extend it. Could this be the beginning of rationing.)

· pp. 1480: Another mention of Advanced Care Planning and it’s mandatory participation including the “end of life” counseling.

· pp. 1484: The frequency of individual participation in Advanced Care Planning increases as health changes.

· pp.1488: Secretary of Health and Human Services determines the quality measures for end of life care and Advanced Care Planning (referred to as ACP).

· pp.1491: Provision for the Secretary of Defense to devise a method of identifying individuals who are eligible for enrollment for Tricare, but have not enrolled and informing them of their eligibility. (If they are doing this for Tricare, what is to stop them from doing the same for other health insurance programs?)

· pp. 1499-1510: Authority given to the Secretary of Health and Human Services to establish a program to promote primary care, mental health services,& coordinated care without judicial review or any challenge. (This is the second instance where the Secretary is allowed complete control over something and cannot be challenged. Sounds more like a power grab than anything else.)

· pp. 1545: Provision for Coverage for Marriage and Family Therapist Services. (Apparently the government want to make sure that beside physical health, we are also provided with mental health. However, All of the provisions for counseling can easily be used to control people.)

· pp. 1885: Fee imposed on specified insurance policies.

· pp. 1886: Fee imposed on self-insured health plans

· pp. 1893 lines 13-22: States can apply to the Secretary of Health & Human Services for a grant to provide home visitations for children and families expecting children.

· pp. 1902 line 20-24: States that receive such grants must submit reports to the Secretary of Health & Human Services concerning home visitations.

· pp. 1920: This talks about obligated service in the Primary Care Workforce. (I’m not certain who all is required to be part of this obligated service.)

· pp.1925 lines 8-14: The Secretary if Health & Human Services can set up Frontline Health Providers Loan Repayment Program

· pp. 1958 line 17-24: Establishment of Public Health Workforce Loan Repayment Program

· pp. 1990 lines 5-12: The Secretary (of Health &Human Services) has to provide to Congress and National Strategy of improving the Nation’s Health.

· pp. 1992: Establishment of a Task Force on Clinical Prevention Services

· pp. 2056 line 21-24: National Medical Device registry

· pp. 2098: Section of House Committee on Education And Labor begins

o This section seems to deal with Grants and financial aid to college students

· pp. 2152: Section on Student Loans—This seems to be mostly amendments to an earlier section of the bill.

· pp. 2205 line 14: Grants for Public School Facilities

o pp.2214: Alabama, Mississippi, & Louisiana get supplemental grants to improve the structure of their schools

· pp.2221 line 3: Begins a section of funding for “Green Schools”

· pp. 2227 line 7: Establishment of Advisory Council on Green, High Performing Public School Facilities.

· pp. 2241 line 19: Begins section on Early Learning Challenge Fund

pp. 2301 line 12-23: “OPEN ONLINE EDUCATION.—From the amount appropriated to carry out this section, the Secretary is authorized to make competitive grants to, or enter into contracts with, institutions of higher education, philanthropic organizations, and other appropriate entities to develop,evaluate, and disseminate freely-available high-quality on

line training, high school courses, and postsecondary education courses. Entities receiving funds under this subsection shall ensure that electronic and information technology activities meet the access standards established under section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d).”

August 20, 2009

Dear Mr. President,

Tuesday, August 11, you graced us with another Town Hall meeting. This seems to be the only thing you are good at. You have become quite adept at using these staged events to push the liberal agenda. Once again your entire speech was filled with one lie after another. You never answered any of the questions (if they could be called that) that were asked. Are you incapable of answering questions directly? Or are you too much of a coward?

You mentioned in your speech that people “are held hostage by health insurance.” People are not held hostage by insurance companies. Whether an insurance company pays for something or not, people still have access to high quality medical care. Hospitals will work with individuals who are unable to pay up front. Apparently you are under that assumption that people will only receive the treatment they need if their insurance agrees to pay the cost. But here’s a question: if the government insurance program refuses to pay for medical care, then by the same logic are you not held hostage by the government?

Once again you want us to believe that the stimulus bill is working. If so where is the evidence? The only jobs created are federal and state jobs. The only people benefiting from your stimulus are Union leaders. Unions have always killed capitalism. Government intervention destroys prosperous economies. Private business is what we need. Many businesses have closed their doors, or laid off employees to cover the rising costs that your Stimulus package put on them. Unemployment is close to 10%. And as you’ve said, only a third of the money was spent. If this is the result after only spending 1/3 of the allotted money, why spend the rest. Why don’t you and Congress give the rest of that $787 billion back to the people? The people have always been able to spend their hard earned money better and more efficiently than the government.

The Recovery Act is a failure. You love to mention Bush’s failed economic policies. Unemployment stayed fairly constant that last eight years, as the chart below indicates.

2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
4%	4.7%	5.8%	6%	5.5%	5.1%	4.6%	4.6%	5.8%	9.7% as of July

Figures from www.infoplease.com & http://www.google.com/publicdata?ds=usunemployment&met=unemployment_rate&tdim=true&q=current+U.S.+unemployment+rate

When are you going to quit blaming Bush for your problems?

True to your Marxist principles, you instigate class warfare. The wealthy Americans are not paying enough. In truth, the wealthiest Americans pay more in taxes than anyone else. You stated, “It doesn’t mean we can just sit back and do nothing while so many families are still struggling, because even before this recession hit we had an economy that was working pretty well for the wealthiest Americans, it was working pretty well for Wall Street bankers, it was working pretty well for big corporations, but it wasn’t working so well for everybody else. It was an economy of bubbles and busts.” Karl Marx would be so proud of you. The thing is, when the wealthy prosper, so do the poor. A free market economy always has “bubbles and busts”. The ups are usually long lived and the downturns are short. However, when government steps in to right wrongs that never existed those economic downturns last a long time. This is what you have been doing since January. Though you are only doing what our government has steadily done since F.D.R.

A free market society is the best society any nation can have. It gives all people the opportunity to succeed, but it does not guarantee results. The wealthiest Americans exist because they took the risk of seeking fortune, worked hard, and succeeded. They refused to settle for mediocrity. What you are pushing for is equal poverty. Your health plan will force everyone to pay all that they earn in order to support it. It will destroy business and destroy the economy. This has happened in every nation that has implemented such a plan. The results will be no different here.

Whereas many of the poor in this country remain so because they are dependent on the government for their livelihood. These people are on welfare, collect food stamps, and have Medicaid for health insurance. They have no incentive or desire to improve themselves and their lives.

You yourself are wealthy, Mr. President. You have more money than people can dream of. Many in your administration are wealthy. Are you, or they, willing to give up your wealth to someone who has less than $10,000? Are you willing to donate your money to a non profit charity that lives among the poor day after day trying to help them find work? Since you are unwilling to sacrifice your wealth for the sake of another, then do not force others to do it through a government mandate. You hypocrite.

You and your ilk always make it a crime for people or businesses to create profit from business transactions. You accuse the drug companies and insurance companies of making more money than they should. Who are you to decide how much they should make? Who are you to decide how much anyone should make? Those companies only stay alive because they make a profit and those profits are reinvested in the company. That is how business works. No one has the right to decide how much an individual or a business makes.

You try to use the fact that UPS and FedEx are doing just fine while competing against the Post Office as a reason for government run health care. “It’s the Post Office that’s always having problems,” you said. Maybe this is why the government should not run anything. The Post Office loses money every year. What will make government health care any different? FedEx and UPS came around because of the increasing inefficiency of the post office. They have proven that the government cannot run a business. Insurance, whether health or other, is a business.

You mentioned, “Medicare and Medicaid are on an unsustainable path. Medicare is slated to go into the red in about eight to 10 years.” If Medicare and Medicaid will be bankrupt in 10 years, then why are you expanding these unsustainable programs to cover everyone? Medicare and Medicaid are both government insurance programs done on a smaller scale. If they are bankrupt after 40 years, what makes you think you can just expand them on a national scale and have different results? Trying to use these two programs as a reason to have nationalized health care is a flawed argument.

Another aspect of our current health system that you claim is a problem is the fact that specialists are paid more than general practitioners. There is a reason for that. General practitioners see a wide variety of patients every day. They see more patients than the specialists. Because they see more people per day they can charge less per patient without suffering a huge deduction in pay.

Specialists only concentrate on one area of the medical field. They go through more years of school than your general practitioners. They only see patients that pertain to there area of expertise. A Cardiologist only sees patients with major heart problems. Oncologists see only cancer patients. And so on. That is their specialty. You wouldn’t send someone with a sore throat to these people. You also wouldn’t want a general practitioner treating you if you had cancer or a heart attack. Again, who are you to decide how much a doctor can or cannot make? Doctors are businessmen. Their practices are businesses. Setting restrictions on how much a physician earns compels them to treat less people and not care if their patient get well or not.

You contradicted yourself later when you mentioned that you managed to get “something right like Medicare.” How could the government have gotten Medicare right when it is bankrupt? You said yourself that it is headed on the road to bankruptcy. But you insist that the government got it right. If you believe this, then you have admitted that you think the right course for America is to spend it in to oblivion while taking complete control of private industry.

You addressed on person’s concerns by stating that Medicare benefits will not be cut to pay for this public option. One problem: about a month before you passed a proposal of how to pay for government run health care. One this proposal were cuts in Medicare and the supposed savings from these cuts would help pay for this health care reform of yours. Which is it?

Another portion of your speech states:

“Under the reform we’re proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.

You will not be waiting in any lines. This is not about putting the government in charge of your health insurance. I don’t believe anyone should be in charge of your health insurance decisions but you and your doctor. I don’t think government bureaucrats should be meddling, but I also don’t think insurance company bureaucrats should be meddling. That’s the health care system I believe in.”

Mr. President, why do you continue to lie to us? Page 16 of the House Bill begins a list of requirements that must be met in order for individuals to be allowed to keep their current insurance plan. If none of those measures are met, they lose their insurance, forcing them on the government option. How is that allowing people to keep their current health insurance? There is a similar list for employer based insurance.

This bill has provisions for establishing advisory boards for everything: preventative care, use of medical practices, care received, prescriptions and so. With all of these health advisory boards, not only is there going to be a new bureaucracy formed, meaning increase government control, but what is to keep these boards from determining who your doctor is, what medical care you will be allowed to receive, or how much care you will receive? These boards will be headed by government bureaucrats. Who controls them? Another bureaucrat?

Either you do not have a clue of what is in this bill, or you do and do not care. I believe it is a combination of both. You know full well that this supposed reform imposes new taxes, cuts Medicare benefits, rations care, dictates the kind of medicine people can have and extends government control over every aspect of people’s lives. You know this and you do not care if it results in economic disaster, Americans being denied health care, or kills the ingenuity and initiative that drove us to develop better treatments for diseases.

Mr. President, your entire speech at this meeting is the equivalent of what comes out of a horse’s ass. You couldn’t even answer the pitiful questions that were asked. Instead, you continued to sell us a bushel of lemons. You claim to care about average American. You are a liar. You don’t care about the people. You just use them to get your government programs passed. You use the status quo, “the people,” to get what you want and if these measures fail you can stay afloat by claiming that you were only trying to help. Or, that your measures kept things from being worse.

Sincerely,

Lady Liberty

This is a copy of an article at CNN.com.  You can read the original at: http://money.cnn.com/2009/07/24/news/economy/health_care_reform_obama.fortune/index.htm

5 freedoms you’d lose in health care reform

If you read the fine print in the Congressional plans, you’ll find that a lot of cherished aspects of the current system would disappear.

NEW YORK (Fortune) — In promoting his health-care agenda, President Obama has repeatedly reassured Americans that they can keep their existing health plans — and that the benefits and access they prize will be enhanced through reform.

A close reading of the two main bills, one backed by Democrats in the House and the other issued by Sen. Edward Kennedy’s Health committee, contradict the President’s assurances. To be sure, it isn’t easy to comb through their 2,000 pages of tortured legal language. But page by page, the bills reveal a web of restrictions, fines, and mandates that would radically change your health-care coverage.

If you prize 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 could lose all of those good things under the rules proposed in the two bills that herald a health-care revolution.

In short, the Obama platform 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.

Let’s explore the five freedoms that Americans would lose under Obamacare:

1. Freedom to choose what’s in your plan

The bills in both houses require that Americans purchase insurance through “qualified” plans offered by health-care “exchanges” that would be set up in each state. The rub is that the plans can’t really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.

Today, many states require these “standard benefits packages” — and they’re a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.

The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure “children” until the age of 26. That’s just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts. Americans, therefore, wouldn’t even know what’s in their plans and what they’re required to pay for, directly or indirectly, until after the bills become law.

2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Americans with pre-existing conditions need subsidies under any plan, but community rating is a dubious way to bring fairness to health care. The reason is twofold: First, it forces 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. The state laws gouging the young are a major reason so many of them have joined the ranks of uninsured.

Under the Senate plan, insurers would be barred from charging any more than twice as much for one patient vs. any other patient with the same coverage. So 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.

Second, the bills would ban insurers from charging differing premiums based on the health of their customers. Again, that’s understandable for folks with diabetes or cancer. But the bills would bar rewarding people who pursue a healthy lifestyle of exercise or a cholesterol-conscious diet. That’s hardly a formula for lower costs. It’s as if car insurers had to charge the same rates to safe drivers as to chronic speeders with a history of accidents.

3. Freedom to choose high-deductible coverage

The bills threaten to eliminate 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.

Hundreds of companies now 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.

The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. “The government could set extremely low deductibles that would eliminate HSAs,” says John Goodman of the National Center for Policy Analysis, a free-market research group. “And they could do it after the bills are passed.”

4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise. It’s worth diving into the weeds — the territory where most pundits and politicians don’t seem to have ventured.

The legislation 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. Those are the GEs (GE, Fortune 500) and Time Warners (TWX, Fortune 500) and most other big companies.

The House bill states that employees covered by ERISA plans are “grandfathered.” Under ERISA, the plans can do pretty much what they want — they’re exempt from standard packages and community rating and can reward employees for healthy lifestyles even in restrictive states.

But read on.

The bill gives ERISA employers 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 we’ve already discussed. 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.

The outlook is worse for the second group. It encompasses employees who aren’t under ERISA but get actual insurance either on their own or through small businesses. 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 employees who got their coverage before the law goes into effect can keep their plans, but once again, there’s a catch. If the plan changes in any way — by altering co-pays, deductibles, or even switching coverage for this or that drug — 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.

5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges — and as we’ve seen, that will soon be most Americans — must get their care through something called “medical home.” Medical home is similar to an HMO. You’re assigned a primary care doctor, and the doctor controls 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.

Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was 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.

The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges. But remember, those plans — if they exist — would be barred from charging sick or elderly patients more than young and healthy ones. So patients would be inclined to game the system, staying in the HMO while they’re healthy and switching to fee-for-service when they become seriously ill. “That would kill fee-for-service in a hurry,” says Goodman.

In reality, the flexible, employer-based plans that now dominate the landscape, and that Americans so cherish, could disappear far faster than the 5 year “grace period” that’s barely being discussed.

Companies would have the option of paying an 8% payroll tax into a fund that pays for coverage for Americans who aren’t covered by their employers. It won’t happen right away — large companies must wait a couple of years before they opt out. But it will happen, since it’s likely that the tax will rise a lot more slowly than corporate health-care costs, especially since they’ll be lobbying Washington to keep the tax under control in the righteous name of job creation.

The best solution is 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). I’ll propose my own solution in another piece soon on Fortune.com. For now, we suffer with a flawed health-care system, but we still have our Five Freedoms. Call them the Five Endangered Freedoms. 

Everyday we are told that we need health care reform. Obama claims that the nation’s health care system needs to be overhauled and that he is the one to do it. Obama, Liberals and Democrats, the major media, and nearly every American believes that the health care system in this country is broken. People are told every day that if nothing is done, if the government doesn’t do something, then health care in America will vanish. People will not have access to medicine. The country will go bankrupt.

The truth, however, is that all of this is nothing more than fear mongering. Obama and his liberal friends want you to be frightened of losing your current health care coverage so that you will go along with their solution. The thing is, the solution being offered is the cause of the problem.

Obama claims that about 46 million Americans are not insured. No one bothers to ask why they have no insurance. It is assumed that these people want insurance but are unable to afford it or get it from an employer. The fact is that approximately 17.6 million of these 46 earn $50,000 or more a year and about 10 million earn more than $75,000 a year. People who earn this much tend to pay for their health care out of pocket. Therefore, they do not need insurance. Basically about 38% of these 46 million who are uninsured earn enough money to afford it, but choose not to have it. This 46 million uninsured is a number thrown around by politicians, Obama, and the media to gain sympathy from you.

The population of the United States is roughly 300 billion. The fact that 46 million people might not have health insurance is the least of our problems. The majority of Americans have health insurance whether it is through their employer, a private insurance company, or the government. There are a variety of reasons for why individuals do not have insurance. Affordability is at the bottom of the list. Most people do not carry health insurance for two reasons: they do not want it, or they don’t need it.

But here is a fact no one bothers to mention. Every American has access to health care. A person is never denied access to a doctor or a medical procedure because they don’t have insurance. The difference is, they pay for it directly out of their own pocket instead of waiting for a third party to cover the cost from money that they sent in over a period of time.

Whenever we purchase items from a store we pay for it directly right then and there. Why should medical care be any different? When you pay for medical care directly, you only pay for what you use and pay less than what you would through an insurance company or if you relied on the government. You are ultimately responsible for paying for your health care. It is your responsibility to go to the doctor when needed and then pay for it. It has never been the government’s responsibility to cover your medical costs. Such measures violate the U.S. Constitution and degrade individuals. It also robs us of you of your liberty.

Obama claims that universal health care will bring competitiveness to private insurance companies. This is a blatant lie. In every country that has had socialized medicine the private sector was destroyed, leaving people with only one option: the government’s program. The private sector has never been able to compete with the government. The private sector depends upon profit to stay in business. When the government steps in and says “free” the private sector disappears.

Obama claims that rising health care costs caused the deficit. Anyone with an ounce of common sense knows that this is absurd. What about the $700 billion stimulus bill that he passed back in January? How about the amount of spending that the government does every year with no regard for the fact that they do not have the money? How about all of the pork barrel spending that is snuck through on every bill that goes through Congress? All of this caused and adds to the deficit. If Congress and our current president cannot control their spending, the deficit will never get paid off, despite current health care costs.

The fact is, our nation is bankrupt. We have no money. The value of the dollar continues to fall. As a nation we continue to borrow more from China to pay for all of Congress’ spending. The two government run health insurance plans in this country are bankrupt. How can we as a nation afford a single payer system like what Canada has? We can’t.

People believe that Obama is pushing health care reform because he cares about them. Obama, like all politicians, does not care about anyone but himself. He doesn’t care about you or the fact that people are without health insurance. Obama sees this as an opportunity to seize more power and he is using it. If our Congress, and if Obama really cared about the people’s access and ability to pay for health care, they would be pushing for less government involvement. They would be pushing for an end to Medicare, an end to Medicaid, and for deregulation of the health care sector.

Here is another question: why are we moving towards universal health care when the countries that already have it are moving towards privatized medicine? We have had Medicare and Medicaid for about forty years. In that time they proved that government run health care does not work. Why is our government expanding these programs instead of getting rid of them?

In short there are five reason to ditch Universal healthcare in all of its forms:

1. Government run health care is unconstitutional

2. Government run health care does not work.

3. Government run health care drives up the cost of medicine and limits access

4. Countries with it are moving away from it.

5. This is the United States of America not Europe. It is time that we quit emulating Europe and be Americans with American innovations and American solutions.

This country was built by people who were fiercely independent, did not rely on the government for anything, solved their own problems, and did not bitch, whine or complain when things were not fair. They told the government where to stick. It’s time we do it again.

Here in the United States people believe that we have a privately run health care system. The fact is we do not. We have a third party payer system that is heavily regulated by the federal government. We also have government run health care. The majority of our health care system consists of numerous insurance companies. People pay an insurance company monthly premiums so that when they go to the doctor their insurance company will pay the cost. In the end, the individual still pays the cost of their medical needs. They just pay for it indirectly through an insurer.

One problem with paying for healthcare this way is the amount of paperwork that springs up in the billing department. Forms are filed with the insurance company concerning the visit to the doctor. The insurance investigates the claim. The hospital bills the insurance company and they decide how much they are willing to cover. Then a bill for the remaining amount is sent to the patient. All of this paper work between the doctor’s office and the insurance company adds up. Someone has fill out these insurance claims/billing forms, file it, send it, keep track of it, and be able to find it if there is an investigation concerning insurance fraud. The people who keep track of all this paperwork and the bureaucracy have to be paid.

Another problem with the third party payer system is that no one, not even doctors, know how much medical procedures, doctor’s visits, medical tests. or medications actually cost. Without that knowledge people end up paying for medical procedures, tests, and prescriptions they do not need. Since people do not pay for health care directly they end up paying for procedures and drugs they do not need. People will also take expensive drugs even when the generic is just as good, if not better.

The government is another third party payer when it comes to medical care. The government’s health insurance is accessible only to the elderly and the poor known as Medicare and Medicaid. Everyone pays for this health coverage through taxes including those who do not receive Medicare or Medicaid pay. Again, when a patient goes to the doctor they do not pay the cost of the visit up front. The doctor gives the bill to the billing department. They in turn bill the government, the government pays the hospital, which then pays the doctor. Again there are massive amounts of paper work for all of this and someone has to file it.

Let’s take a look at our first government run health care program: Medicare. Medicare is the government’s answer to providing health care to the elderly. It was first implemented in 1966. For over forty years anyone over 65 has been forced into this program. They have no choice. We are told that Medicare is essential for our elderly. That without it, they would not have access to health care. They would not be able to afford medical procedures and would end up on the streets in bankruptcy. The problem is, Medicare is bankrupt. The government keeps it limping along with their ventilator of taxpayer money.

There are two parts to Medicare. Part A is the mandatory program that everyone 65 and over must enroll in. It is the program that most are familiar with. Part A provides premium free coverage for old folks. It also covers hospital stays and limited follow up services. Mandatory payroll taxes finance Part A. This tax was implemented based on the government’s estimates of how much this program would cost. But the government couldn’t account for the exploding costs of Medicare. There are more people in the program than there are those able to pay taxes. The reasons for these mounting costs is the expansion of Medicare’s benefits, inflation, increased used of medical facilities, and a far bigger aging population than anticipated. With the baby boomers approaching retirement, the funding for Medicare will not be enough to cover the costs of their medical bills.

Part B is the other portion of Medicare and one few know about. It is voluntary for those over 65. This program provides supplemental insurance with a $100 deductible to Part A. Those enrolled pay a monthly premium. In 1995 their premium was $46.10. This premium only covered 29% of the cost, the rest is paid for by the taxpayer. Physician services, lab tests, outpatient hospital services, and other medical services are covered by the Part B program. But even with Part B, it is not enough to cover all the costs of the medical care provided for the elderly.[i]

Most of the costs for Medicare are wrapped up on the bureaucracy that constitutes it. These bureaucracies are minute in the private sector. Bureaucracies follow every government program and always increase the costs of these programs. There is a lot of paper work associated with Medicare as hospitals must file with agencies in the government, and those files are sent to other agencies, and so on.

Just like socialized medicine of other countries, Medicare relies on price controls. Controlling the costs of something does negate its actual cost. Price controls undermine the value of a doctor’s labor and the procedures used. It also forces the costs of medical procedures to be shifted. These price controls do not control the rate at which Medicare costs have grown. In 1995, medical inflation increased by 4.7%, but employer health premiums decreased by 1.1%. But Medicare had grown by about 10% and its costs are expected to continue to rise. This is not a healthy combination.[ii]

Because of rising costs, Medicare rations its benefits. There is no freedom in Medicare to choose your benefits. It is a one size fits all program, just like every other welfare program. Medicare decides whether a patient receives a medical procedure or not. If you need chemotherapy, but the government thinks you are too old, or that it will cost too much, Medicare simply denies payment for such procedures and you are left with the bill, or no chemo. The older you get, the less Medicare covers your medical costs. Medicare lacks catastrophic coverage. Something routinely found in private insurance plans. Other aspects of medicine denied by Medicare are: preventative screenings, routine physical exam, home nursing care, smoking cessation, and home physician visits.[iii]

Another fallacy of Medicare is its resistance to innovation. Government always stifles innovation. All of our greatest inventions were done by individuals who worked on their own time with their own money and refused government help. When has the government ever invented something that benefitted mankind? Medicare is run by the HCFA (Health Care Financing Administration). HCFA issues hundreds of pages of regulations and thousands of pages of guidelines to manage every aspect of Medicare. No one can breathe under all of these regulations. HCFA decides guidelines for every piece of medical equipment and whether each new device or procedure meets its criteria for coverage under Medicare. This makes it impossible to implement new equipment for medical procedures. Medicare also refuses to reimburse hospitals for using new medical practices or prescribing new drugs. Because of this, doctors do not prescribe drugs new on the market, nor do they conduct tests or medical practices that involve new equipment. The old folks in this country are denied access to innovations in medicine because Medicare will not pay for it and they can’t pay for it themselves.

Medicare is the second largest entitlement program in the United States. Social Security is the first. Like Social Security, Medicare has no money. Medicare is paid for through payroll taxes on employees, self-employed, and employers. But taxes alone do not provide enough money to pay for it, despite an increase in taxes. The government is left with diverting funds from other programs or areas of the federal budget to cover the remaining costs. But this only buys time for an already failed program.

Many believe that the revenue raised for Medicare go in a trust fund, just like Social Security. But there is no trust fund. There never was. (Social Security has no trust fund either.) All revenue generated for Medicare is immediately spent. Most of the benefits received by the elderly exceed what they paid in their payroll taxes. The cost of Medicare continues to grow faster than the economy. They will continue to rise even in this recession. The amount taken from you to pay for Medicare go to someone else or pays for the amount of paperwork that is processed. It will never be spent on you. By the time you are eligible for Medicare, it will not be able to cover your medical needs.

An interesting thing to note is that not everyone is forced into Medicare. Federal employees and members of Congress are exempt from Medicare. Instead they are allowed to receive better health insurance plan that is privately run. They are enrolled in the FEHBP (Federal Employees Health Benefits Plan). This is partly why Congress refuses to fix Medicare. They have no incentive to since they are exempted from their own government run health care program.

Medicaid is the other government run health insurance plan. It too is bankrupt. Medicaid is for the poor, those who are under 65 but cannot afford private insurance. Unlike Medicare, Medicaid is run on both the federal and the state level. Medicaid is also paid for by taxes. This is no surprise. Most of our taxes goes toward funding programs such as, Social Security, Medicare, Medicaid, unemployment benefits, and other welfare entitlement programs. These also make up the biggest spending areas of the federal budget. The cost of Medicaid is increasing at an exponential rate. The federal government cannot generate enough money from taxpayers to keep it running so they divert funds from other parts of the federal budget.

In 2003 13% of federal spending went to Medicaid. By 2015 it will consume 2% of the U.S. GDP.[iv] Between 1995 and 2005 Medicaid doubled in cost. Medicaid isn’t only expensive for the federal government but also for the states. By 2003 Medicaid surpassed education has the biggest expenditure of their spending. 22% of state budgets go toward Medicaid.[v]

Medicaid does vary from state to state in how it is run and in what is covered. The federal government requires certain mandatory coverage, but the states choose whether to go beyond that. Two thirds of Medicaid’s spending is on services that the federal government classifies as optional. Like Medicare, Medicaid is plagued by a bureaucracy that welcomes wasteful spending. Typical with most government programs, the people suffer.

Medicaid does not fully reimburse doctors for treating patients that are insured through it. It does not cover the entire cost of prescription drugs, nor can it. Medicaid is forced to cut its benefits in order to save on its expenses. Its reimbursements continue to decrease while its bureaucracy continues to grow. Because of this, many physicians refuse to treat people who are insured through Medicaid. A physician is more likely to be paid for their service by private insurers than by Medicaid. This forces them to stop accepting new Medicaid patients.

As with Medicare, many beneficiaries of Medicaid do not have access to prescription drugs. Doctors have to wait for permission to prescribe medication to those on Medicaid. This means that many wait for drugs they desperately need, if they ever get them in the first place. Even if a patient manages to be OK’ed for prescription drugs, limits are placed on the amount they can receive. Preventative medicine and procedures are denied to many Medicaid patients because Medicaid cannot afford to pay it.

Both Medicare and Medicaid reflect what happens with government run healthcare. The government cannot afford to keep these programs going, but they do so anyway at the risk of bankrupting the nation. Taxpayers can only pay so much to fund these two programs. Even if people paid 100% of their income in taxes, it still would not be enough to cover the costs. As a result, the government passes the expenses onto the private sector. This is why premiums of private insurance companies are increasing. Insurance companies are forced to pay for the government’s insurance plan.

Basically, there are three ways people pay for their medical needs. Below is a simplified diagram:

1. You-à pay doctor directly

2. Youà pay monthly premiums to insurance company-à pay billing department-à pay doctor

3. Youà pay taxes to government-à federal bureaucracy-à state bureaucracy-à county/local bureaucracy-à billing department-à pay doctor

The more people there are between you, the patient, and the doctor, the higher the medical costs. Prices always increase when there is a middleman. The U.S.’s current healthcare system can have up to whole groups, buildings, and offices of middlemen. All of whom want their cut of the profits.

President Obama wants to make sure that every American has health coverage, provided by the government of course. This means universal health care. This idea is not new. Many in Congress have been pushing for socialized medicine for the past two decades, or more. Sweden and Great Britain were two of the first western countries to institute state run health care. They have had government run health care since 1948. Over the decades other nations such as, New Zealand, Australia, Cuba, and Canada have all instituted government run healthcare.
Sweden is often referred as a country that has the most equalization. It’s true, if you believe in equal results rather than equal opportunity. Sweden is the most socialist country in the world. And they have state run health care. Many people look to Sweden as an example for how a healthcare system should be run. After all they provide the best healthcare to all of their citizens. They have equal coverage, equal access, high quality care, a longer life expectancy than in the U.S., and their health care is free.
But if Sweden’s health system is so great, then why are they privatizing parts of it? The reality is their health system is fading. Proponents for universal care point out that Sweden’s experiment with profit driven health care is not working. They are right. But not because competition fails. The reason for its failure is that the bits of privatization in Sweden’s health care system are not truly private. They are still heavily regulated by the government.
Sweden only spends about 8.4% of their GDP (Gross Domestic Product) on their health care. But GDP alone is not a measure of how well a country is performing. Health care in Sweden suffers from increase costs, lack of doctors, and long waiting lines. In a ten year period, 1980-1990, the cost of Sweden’s healthcare rose by 145%. Despite price controls on the cost of drugs, doctor visits, and medical procedures, the cost of healthcare in Sweden is increasing.
Sweden suffers from long waiting lists. Patients stand in long lines to see a doctor. Security guards are common in their clinics to ensure there are no riots. They also refuse to let new people enter if the clinic is full. Patients are denied newer, better medicines because they cost more than the older prescriptions. Patients are denied the option of paying for prescription drugs themselves because it would cause “unequal access”.
Great Britain was one of the first countries of western culture to institute nationalized healthcare. They have had it since 1948. The people there suffer from long lines, denied medical procedures, denied drugs, and inferior equipment. English hospitals are routinely over crowded causing a shortage of beds, which in turn means that patients are turned away. Overcrowded hospitals increase the risk of infections spreading from patient to patient. It is reported that at least 7,000 patients suffer from infections and that 5,000 of those die from them. One of the reasons for overcrowded hospitals is England’s attempt to cut the waiting lines. They have passed reforms to cut back on the time people spend waiting to have surgery or see a specialist. There are many stories about patients not receiving the care they need. Many cancer patients are unable to see a surgeon or receive the medication they need.
And then there’s Canada. Our neighbor to the north. Everyone talks about Canada’s health whether they are pro or con nationalization of health care. Canada spends about 10% of their GDP on health care. We see news reports about how Canadians love their health care system. They’re smiling. They cannot understand us Americans and why we resist such a great system. People only wait 30 minutes at a clinic to see a doctor. They don’t have to pay for the visit or the prescription. They don’t pay for surgery. Canadians do not pay for one cent of their healthcare needs. At least, this is what we are told. And this is what many people believe. The truth is, Canada’s health care is not free. It never was. Canadians do pay for their health care. They just pay for it indirectly through taxes.
At least 22% of all taxes collected go to health care in Canada. Canadians pay an income and sales tax and employer based premiums to generate revenue for their healthcare. In 2005 citizens from Ontario pay 40% of their tax dollars toward healthcare and the figure is on the rise. The costs are borne by the federal and provincial levels in Canada. But lately Canada’s federal government has had to cut back on how much they spend on healthcare. Much of the responsibility is being shifted to the provinces. Of all the industrialized countries that have universal healthcare, Canada spends the most. But it ranks at the bottom for access to healthcare, according to the OECD (Organization for Economic Co-operation and Development). “It is 17th out of 20 for its doctor/patient ratio—only 1.8 doctors per 1,000 citizens, 17th for availability of CAT scanners, and 18th for MRIs.” Here is a table of average wait times:

Wait Time (Weeks) Procedure Waiting For
16.5                                    Time between referral from a general practitioner & treatment
8.5                                      To see a radiation oncologist
5.2                                      For a CT scan
12.4                                    For and MRI
3.2                                      For an ultrasound
20                                       Time between seeing specialist to surgery for hip replacement (after waiting
13 weeks to see the specialist in the first place)

(Houston Kerri, Acces Denied: Canada’s Healthcare System Turns Patients Into Victims, December 2003, The Center For Civic, Family, and Social Progress Policy Perspectives, vol. 10, Issue 6. http://ff.org/centers/ccfsp/pdf/CCSFP-PP-Winter-03.pdf (I put the figures in a table to make them easier to read.)

Canada also suffers from long lines, lack of access to newer and better technology, hospital beds, and prescriptions medication. However, Canada also suffers from a shortage of physicians. Doctors are leaving Canada. They cannot charge more than what the state allows for their services meaning that they are paid the same no matter how many patients they see or the quality of care they provide. Sometimes doctors have to send payment back to the government because they saw more patients than what the government mandated they could tend. As a result, doctors quit caring about their patients’ well-being. There’s no need to. Those physicians who truly want to help people have been prevented from doing so. In the 1990s roughly 10,000 Canadian doctors left the country.
On top of doctors leaving, there are few replacements graduating from medical schools. The Canadian government has put limits on the amount of enrollments for medical schools. Only 1,530 people graduated from Canadian medical schools in 2002. There are not enough doctors to replace those who leave or retire. Ontario alone claims that “nearly 80% of its regional communities are listed by the provincial government as being ‘underserviced’ due to physician shortages”.
Prescription drug coverage in Canada is no better. Drug prices are controlled by the state. Drugs are also approved by the government. This makes it difficult to get newer drugs on the market since in an effort to control cost the government will not approve them. These new drugs may be more effective, but they are also more expensive. Canadians only have access to the drugs allowed by the government. Even if they are willing to pay for the medicine themselves, they are not allowed to buy it. So, many Canadians come to the United States for their medicine. Another problem with mandated drugs by the state is that the government can change a person’s prescription to something more generic and cheaper without consulting the patient or the physician. Many Canadian are hospitalized because of a sudden change in their prescription and the side effects that occur. Drugs are not cheaper in Canada. They appear to be because of price controls, but their prices are higher than what we pay in the United States.