The web we weave


I am sitting here reading the two hundred and sixty two pages of the America’s Healthy Future Act of 2009, the Senate Finance Committee attempt at health care reform. Likely the healthiest part of all this is in the growth of bureaucracy. I am saying to myself how did we get into this morass, and this bill is simple compared to the House legislation. 

How did we get to the point where the Congress of the United States is writing laws that talking about pre-existing conditions and premium ratios, and young invisible policies?   How did we convince ourselves that we could reform the national health care system by mandating coverage limits and then allowing the various states to opt out of the national system?  How do we have a uniform system of anything and still allow the states to pass more rigorous laws that subject insurers to more regulation beyond what will be required at the federal level? 

Hmmm, where did I put that regulation on available credits for Medicine Men?
Hmmm, where did I put that regulation on available credits for Medicine Men?

How do we justify a complex scheme to raise revenue by taxing so-called Cadillac plans after adding a score of mandates that add to the cost of health benefits? How did high-income people or manufacturers of medical equipment become funding vehicles?  How do we manage such a system or more accurately non-system?  How do we manage a law that says physicians who order more tests, get less money from Medicare or a system that takes money from one part of Medicare and the beneficiaries who use that system and then claim that everyone can keep their current plan and physician? 

How indeed?  In fact, we can’t, nobody can manage this and claim and savings or improvement in much of anything and yet, we still move forward at full speed creating more and more programs on top of Medicare, Medicaid, CHIP, the veterans system and I am not sure exactly what else is out there providing “affordable” health care. 

This could be a lot simpler of course, we could have simply said every American will pay an additional payroll tax of 4% to subsidize the low-income people, Open Medicare to all those who cannot obtain private coverage, eliminate Medicaid and all the other programs and make Medicare the program of last resort. Require that employers of a certain size offer a minimum benefits package and all others pay a matching percentage of the payroll cost for their employees who enroll in Medicare.  Does this solve all of the ills of the system, nope, but then again neither do the thousands of pages contained in all the proposed legislation. 

Samples from the Senate Finance Committee 

2 Chairman’s Mark

The Chairman‘s Mark would establish Federal rating, issue, renewability, and pre-existing condition rules for the individual market. Issuers in the individual market could vary premiums based only on the following characteristics: tobacco use, age, and family composition. Specifically, premiums could vary no more than the ratio specified for each characteristic: 

 Tobacco use – 1.5:1

 Age – 5:1 4:1 

 Family composition: 

o Single – 1:1 

o Adult with child – 1.8:1 

o Two adults – 2:1 

o Family – 3:1 

Or,  Any individual who has an existing policy equal in value to the ―young invincible plan (described below) can renew that policy.   

State Opt-Out 

Beginning in 2015, the Chairman‘s Mark provides an opportunity for states to apply for a waiver to opt out of certain aspects of this Act through a waiver process. States may be granted a waiver if the state applies to the Secretary to provide health care coverage that is at least as comprehensive as required under the Chairman‘s Mark. States may seek a waiver through a process similar to Medicaid and CHIP. If the State submits a waiver to the Secretary, the Secretary must respond no later than 180 days and if the Secretary refuses to grant a waiver, the Secretary must notify the State and Congress about why the waiver was not granted. 

The Mark requires states to meet the requirements of this Act such that all residents have affordable, quality insurance coverage shall be eligible for a waiver of applicable Federal health-related program requirements.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s