Stamping out Socialism

I've been reading the new health reform laws. I've downloaded them both -- a total of 1,000 pages; half a million words of mind-numbing legislative prolixity. I've read about a fourth of it carefully and all of it at least cursorily.

My ostensible reason for doing this is that I have a free-lance gig to write a series of articles for the Healthcare Financial Management Association and I need to research the original source material. But my real reason is that I want to stop socialism. I want to take our country back for real Americans. And I want to prevent the federal government from touching Medicare.

But ... I have a problem. The more of the actual legal language I read, the more things I find that sound down-right reasonable. For example, the larger of the two bills (Pub. L. No. 111-148) does the following in just the first section after the table of contents:

- prohibits lifetime and unreasonable annual limits on coverage
- prohibits cancellation of policies except for fraud or intentional misrepresentation
- requires insurance to cover preventive health services
- extends dependent coverage of unmarried children to age 26
- requires uniform explanation of coverage documents
- prohibits discrimination in coverage based on salary (big wigs can't get better care)   
- requires effective appeals processes for denial of coverage
- requires insurance companies to report the percentage of premium dollars they actually spend on paying claims (instead of on administrative costs and profit).

Here are some other things that caught my eye:

• Sec. 1201 prohibits discrimination based on preexisting conditions and guarantees that coverage will be available to everyone.

• Sec. 1251 preserves my right to keep my current health plan if I want to.

• Secs. 1301-1343 provide money to the states to form their own state-run or nonprofit insurance "exchanges" to offer basic insurance that wouldn't otherwise be available.

• Other parts of the law improve coverage of Medicaid for poor people, link Medicare payments to quality outcomes, and set up various studies and demonstration projects (such as on quality issues, training of healthcare workers, and prevention of chronic disease).

• There are 120 pages on "transparency and program integrity," which essentially means prevention of fraud and abuse.

• Sec. 6703 is an entire new law called the Elder Justice Act to protect against abuse, neglect and exploitation of the elderly.

• And there's a voluntary insurance program in Secs. 8001-8002 for "community living assistance services" (essentially, home care for people who need help with the normal activities of dailing living; i.e., the elderly and disabled). This includes advice on decision making at the end of life.

Aha! Finally! When I read this last item I thought I'd struck gold: "Death panels! They're going to kill granny!" But then I read the fine print. It just says someone will be available, when requested, to advise about options such as living wills, health care proxies and advance directives. Drat! That's nothing new; people get that information already in Patients' Rights brochures and elsewhere.

So I'm bummed out. I can't find a communist conspiracy anywhere. There is, to be sure, a lot of technical, financial stuff about taxes and reductions of payment rates to doctors and hospitals. The Congressional Budget Office says that to cover an additional 32 million people will cost a bit more than $900 billion over ten years and that there are cuts and taxes and fees that will cover that amount. They also say the law will reduce the deficit by $124 billion over ten years compared to what it would have been. All of these estimates assume the laws will remain unchanged over the next decade, which of course they won't. I'm not qualified to assess the CBO's work. I know that Republicans take issue with it and Democrats agree with it. It really doesn't matter -- reform is a done deal. It'll get tweaked, but like Social Security and Medicare, it's now part of the fabric of our country.

But in the meantime, I will keep digging. Marx or Lenin or Castro or Mao must be behind this plot somewhere, and I'm going to find out where.

And don't forget: KEEP YOUR DAMN GOVERNMENT HANDS OFF MEDICARE!