Several states have already begun such social experiments. Massachusetts for example, has a state-wide program. Illinois has a plan to insure all Illinois children. California is also working towards universal health care.

The tenth amendment states:

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States repectively, or the people.

There is nothing in the Constitution giving the Federal Government powers over health care. The solution, therefore, isn’t a federal government takeover or revamp of health care. The solution looks more like less federal government. Among other options, the following should be explored;

• Increase competition by removing restrictions on interstate competition among insurance companies
• Aggressively target and eliminate fraud, waste, and abuse in the existing system
• Reform Medicaid/Medicare, both of which underpay health care providers, which in turn pass the balance on to private payers (insurance companies and individuals)
• Tort reform

In the video, Kavita Patel, who works with Senior Adviser Valerie Jarrett, reads a couple of emails, one of which asks “how are you going to ensure that rationing of services does not occur?” She answers that question by saying that rationing already occurs but at the whim of health insurance companies, “not based on what you should have, not based on the best treatment sometimes, but based on what kind of insurance you have.” While that may be true, it doesn’t go one inch towards answering the question.

She then explains that the president has said “time and time again, If you like your insurance, if you like the kind of health care you have right now and the plan you have, you can keep it.” But that is not true either. If you currently have an employer-based plan and your employer drops that plan and opts to pay the cheaper penalty tax under H.R. 3200, Sec. 313, you will most likely lose your plan.

She then goes on to say the “notion that the government will interfere with what you have is laughable.” That doesn’t quite reconcile with what Obama said while on the campaign trail at the SEIU Health Care Forum in 2007:

I would hope that we could set up a system that allows those who can go through their employer to access a federal system or a state pool of some sort. But I don’t think we’re going to be able to eliminate employer coverage immediately. There’s going to be potentially some transition process. I can envision a decade out or 15 years out or 20 years out where we’ve got a much more portable system. (emphasis mine)

Not so laughable now…

Then the video goes into an interview with Obama where he pokes fun at a woman for telling him “don’t touch my medicare.” I understand he’s trying to be hip and cool and lighten the situation, but is that really presidential of him? But I digress.

Then we cut back to Ms. Patel who continues to remind us that we already have rationing, people are refused care for pre-existing conditions, etc, etc. She goes on to list their intentions with reform but she never counters the fact that rationing will not stop, even with a public plan.

My question to Ms. Patel, or anyone else who can answer it is this; How can you add 54.8 million new people (the number of uninsured as of 2007, the latest census bureau numbers available) to a public option, while not significantly increasing the number of doctors, and not ration health care? The reality is the government will have to ration services for the very same reasons the private sector already does; lack of funding and too few doctors for too many patients.

Still not convinced?

Then take a look at the following entries in H.R. 3200 “America’s Affordable Health Choices Act of 2009″:

Sec. 122, Pg. 29, Lines 4-16

ANNUAL LIMITATION—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).

Sec. 203, Pg. 85, Line 7

(c) SPECIFICATION OF BENEFIT LEVELS FOR PLANS

(1) IN GENERAL.—The Commissioner shall establish the following standards consistent with this subsection and title I:
(A) BASIC, ENHANCED, AND PREMIUM PLANS.—Standards for 3 levels of Exchange-participating health benefits plans: basic, enhanced, and premium (in this division referred to as a ‘‘basic plan’’, ‘‘enhanced plan’’, and ‘‘premium plan’’, respectively).

What could differ from the basic plan to the enhanced plan? The amount of coverage allowed (operative word; rationing).

…under my plan, individuals will be required to carry basic health insurance

Compare that to this:

But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don’t have insurance. No one would be forced to choose it (emphasis mine)

Now consider an employee who works for Company X, which decides it’s cheaper to pay the tax penalty (H.R. 3200, Sec. 313) rather than provide employer-subsidized insurance. Company X’s employees are now left to either buy private insurance or accept the government’s plan. What if an employee can’t afford private insurance or can’t justify the cost when considering her budget? Under this plan, that employee is required to use the public option or pay a 2.5% tax on her income (according to H.R. 3200, Sec. 401.59B, Pg. 167, Lines 18-23). This, to me, is a considerable loss of freedom and forced wealth redistribution. There are those who would say that I already pay for the uninsured through inflated health care costs. To that I reply “no I don’t.” I have a healthy lifestyle, I visit my primary care physician regularly and hence I don’t have large medical expenses. But under this plan, I’ll have no means of avoiding the requirement to help pay for those who aren’t so diligent in maintaining their own health. The government would serve Americans better if it took on metabolic syndrome (for starters) as aggressively as it’s trying to take on health care insurance reform. Next I’d like to address the speed with which this reform, specifically H.R. 3200, was initially rushed through. H.R. 3200 is a 1000+ page bill that was introduced on 7/14/2009, was passed by the Committee on Ways and Means and the Committee on Education and Labor in just three days and the White House was pushing it to be passed before the September recess. But then in his speech to Congress on 9/9/09:

This exchange will take effect in four years, which will give us time to do it right.

Compare that to this:

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true.

So do we need to get health reform now or do we have four years? While we’re talking about families going bankrupt, businesses closing, and Americans losing their coverage, let’s consider this statement made later in the same speech:

Instead of honest debate, we’ve seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise.

Talk of bankrupting families, closing businesses, and Americans losing coverage isn’t a scare tactic?

And now the infamous liar moment:

There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms — the reforms I’m proposing would not apply to those who are here illegally.

AUDIENCE MEMBER: You lie! (Boos.)

Now compare that to this:

July 16, 2009 (Washington, DC) – Today U.S. Congressman Dean Heller (R-NV) offered an amendment to the America’s Affordable Health Choices Act (H.R. 3200) during the House Ways and Means Committee markup that would require the use of existing citizenship verification tools to determine eligibility for taxpayer-funded healthcare benefits. The Heller amendment was defeated. Section 246 of H.R. 3200 does not require the tools necessary to make sure illegal immigrants do not access taxpayer-funded healthcare benefits.

If the reforms do not apply to illegal immigrants then why did the Democrats vote against an amendment to use verification tools to ensure illegal immigrants will not get coverage paid for by American taxpayers? There is also the concern that private companies can’t compete with the government and that this plan will lead to the eventual end of private insurance. In his speech, Obama said this:

Now, I have no interest in putting insurance companies out of business.

Compare that to this: SEIU Health Care Forum, 3/24/07

I would hope that we could set up a system that allows those who can go through their employer to access a federal system or a state pool of some sort. But I don’t think we’re going to be able to eliminate employer coverage immediately. There’s going to be potentially some transition process. I can envision a decade out or 15 years out or 20 years out where we’ve got a much more portable system. (emphasis mine)

Last night’s speech was supposed to rally everyone behind the same goal. It was supposed to clarify that goal as well as the means to achieve it. Instead it was more of the same.

Dear Representative;

I want to thank you for your personal and informative response to my questions regarding H.R. 3200. In your response you asked me to share my views about how to best achieve reform. It is reassuring to have a representative who is actively seeking input from her constituents.

Again, I will keep my response as brief as possible out of respect for your time.

Health care reform is an extremely complex issue that is very personal. Because it so directly impacts me, I have done a lot of reading and research. I have also spoken to my primary care physician as well as my optometrist in order to gain a better understanding of how the system works and how the money flows.

After these conversations, I’ve come away with the opinion that the primary issue we should concentrate on right now is gaining control of and reducing the cost of health care. Health care has become corporatized and impersonal. Bureaucratic waste and greed threatens to choke the entire system. Rather than forcing an 1,100-page ambiguous bill through congress at break-neck speed with no time to read the bill, let alone analyze and debate it, the White House should start with highly publicized Senate hearings meant to take head on fraud, waste, and abuse. The closed-door meetings the Obama administration has had with “Big Pharma” smack of insincerity and impropriety, especially after repeatedly promising quite the opposite (Obama promised to air such meetings and negotiations on C-SPAN).

As well, I would welcome more public education and debate on the matter and less political street-fighting over the issue. We need a clear and concerted message from the government to the public. That message must include exactly what the problem is we are tackling, how the problem is impacting citizens, and the various options being considered. Clarity and transparency are key. All representatives should be leveraging not only town hall meetings, but also social media (Twitter, Facebook, blogs, etc), mailed pamphlets, etc, to engage their constituents and seek their input and participation and frankly to regain their trust.

As a citizen, a tax payer, and a voter, I would prefer to see my government use my tax dollars and my trust to have an open and intellectual exploration and debate of the issue and possible solutions. Engage the population in a process that will have such a personal and direct impact.

The historic election of President Obama seems to have awakened the America voter, especially the younger crowd. It is unfortunate that that fact isn’t being honestly and vigorously leveraged to better the country and to show the world that we are still the greatest nation.

Again, thank you for your time and service.

Dear Mr. Shaw:

Thank you for your very thoughtful questions about H.R. 3200, the America’s Affordable Health Choices Act. I appreciate hearing from you and the fact that you are clearly spending time reading this extremely critical bill.

While I will respond to your questions and hope that you will both continue to get in touch if you need information, I also hope that you will share with me your views about how to best achieve reform. [I did, here] It is important to hear from my constituents on a bill that will be so critical to their health and well-being.

Here are my answers.

(1) Section 152, page 50-51, regarding “personal characteristics.” This is designed to address health care disparities and ensure that high-quality, appropriate care is delivered regardless of a person’s race, ethnicity, gender, age, sex orientation or other characteristics. There may be times when care is differentiated because of health status, for example someone taking a medication for a chronic condition may not be given another medication during an acute care episode. But the intent is to eliminate discrimination on other grounds.

Her answer still left me guessing. A crafty lawyer could conceivably use this as a loophole to have anyone covered, regardless of, say, nationality. Being Swedish is a personal characteristic, no?

Also worth mentioning is the fact that the Congress voted down an amendment, which would require citizenship be verified before receiving benefits.

(2) Section 163, pg 58-59, real-time or near-real determination of financial responsibility. This is designed to give individuals an idea of their costsharing requirements. I have heard from many constituents who would like to be able to know what their out-of-pocket responsibilities would be before they get treatment. While this will require the ability to see whether someone is eligible for assistance based on their income, it is not designed to let providers get access to bank accounts or personal financial data. It would, however, let someone know what their copayment would be, whether their provider is innetwork or not, whether they’ve reached their deductible limit, or if they are close to their annual out-of-pocket limit.

I thought the point was to provide a choice of plans. If I want Plan X and I can afford Plan X, I can buy Plan X. If I choose not to buy any private plan and would rather use the public plan, a plan that I’ll pay for in taxes whether I use it or not, what does my income have to do with my out of pocket expense? When I go to the store to buy a TV, I don’t have to show an income statement to determine the price of the TV. And if a high income predetermines ineligibility, does that also exempt one from the responsibility of paying the taxes that fund the public plan? And if a legal tax payer somehow doesn’t qualify, how can it then be called a public plan?

(3) Section 203, pg. 84, the Commissioner specifying benefits in the Exchange.
Under H.R. 3200, there will be minimum benefit requirements that will be based on the recommendations of a Health Benefits Advisory Commission, headed by the U.S. General Surgeon and determined with public input. However, those benefit packages may change from year to year, as new therapies, drugs and treatments become available. Employers are free to provide additional benefits, states may continue to require their own benefits (as long as they pay the Exchange for any additional costs), and individuals are also free to purchase premium policies that will include extra benefits. Without minimum benefit requirements, insurers could create benefit packages designed to avoid costlier enrollees – for example, not including rehabilitative or mental health services in their benefit package.

It’s clear the government will control what options are available. This will stifle competition and eventually lead to a single payer system.

(4) Section 597B, page 170, section 911. This section creates a penalty for individuals who don’t purchase coverage, based on their adjusted gross income. The section, which is under the sole jurisdiction of the House Ways and Means Committee, amends the Internal Revenue Code. Section 911 refers to the Code, not to H.R. 3200.

This is questionably unconstitutional. The 10th amendment states that any power not delegated to the Federal government nor denied to the States is left to the States or the people. Also of concern, why do wealthier people get punished more for an equal crime?

Again, I hope that I have been able to address your questions. Please don’t hesitate to get in touch if you have additional questions or if! can be of help to you in any way.

Sincerely,

J Schakowsky Member of Congress

P.S. I’ve created an Email Newsletter to provide periodic updates on a variety of issues. You can sign up for it by going to my website at http://www.house.gov/schakowsky.

I guess that’s semantically correct. What they did do is vote against a proposed amendment, which “requires both the President and members of Congress to enroll in any new government-run healthcare”

Congressman Dean Heller (R-NV), the author of the proposed amendment, issued the following statement regarding Congress’s refusal to require participation of the president and congress:

I call on the majority party and the President to lead by example and include provisions in their legislation that requires both the President and members of Congress to enroll in any new government-run healthcare system. If the government-run ‘public plan’ is good enough for millions of our constituents, then it should be good enough for Members of Congress and the President. I do not believe the federal government should be running healthcare in our country and levying massive tax increases on America’s small businesses. However, what better way to monitor a government-run healthcare system than to make federal officials participate in the plan,

21 of 26 democrats on the House Ways and Means committee voted “NO” against the proposed amendment.