Sunday, August 9, 2009


I've been extremely busy in recent weeks and anything not business related has pretty much taken a back seat. But I have made the rounds through the bloggerhood enough to see there is a frothing frenzy of misinformation and demonization developing over the dastardly health care reform. There was enough alarming screed and liars claiming to have read this document to prompt me to start reading the WHOLE document - even though I must do it in small bits of time that I can scrape together these days. Here is what I have gleaned so far:

Section 102 – Protecting the choice to keep current coverage.
This section allows those with current employer coverage to keep it but does require that the coverage meet the minimum requirements set by this bill in 5 years. So there will be a set of standards by which health plans will be judged.

Section 111 - Prohibits pre-existing condtions clauses.

Section 112 – Prohibits the cancelling of health insurance or refusal to renew coverage based on anything but nonpayment of premiums or fraud.

Section 113 - Will limit increases in rates based on factors such as age or location. This section also mandates that a study be done to ensure that the coverage risk is evenly spread out so as not to penalize one group over another.

Section 114 – Prohibits discrimination in benefits for mental health or substance abuse issues.

Section 115 – Ensures that any PPO health plan have an adequate network so the consumer can get in network treatment.

Section 116 – Calls for a medical loss ratio to be met. Simply put, if an insurance company collects X number of dollars from enrollees but pays out for medical expenses less than a preset percentage, they will have to rebate back to the consumer. (It could be argued that this would cut the insurance company’s profits and I suppose that is true – but the other side is it would no longer be profitable for the insurance companies to give that bonus money to providers for NOT performing life saving tests).

Sections 121 & 122 – This outlines what will be expected of all qualified health plans: There will be non-exchange participating plans (mostly current employer plans) and exchange participating plans (the so-called “public” plans).
Limits cost sharing (aka co-pays), requires coverage of medically acceptable items and services.
The plan cannot impose an annual or lifetime limit on any treatment.
A qualified plan must cover: hospitalization, outpatient services, professional services of doctors and other health care professionals, equipment and supplies, prescription drugs, rehab services, mental health and substance abuse treatment, preventative services, maternity and well baby.
No cost sharing (ie co-pay) for preventative and well baby services.
Annual deductible in year 1 will be $5,000 individual and $10,000 for family.
Co-pays until deductible met would be 70%/30%.

Section 123 – Establishes a health benefits advisory committee. They will establish benefits standards.
This section also provides for establishing an Enhanced Plan and a Premium Plan for those who desire to have more coverage.

Section 131 thru 137 – Provides additional consumer protections such as fair marketing practices in regard to health care plans, fair grievance and appeals mechanisms, accurate and timely disclosure of plan details in plain language and includes a provision for advance notice of any plan changes. All plans will have to comply to the same set of standards.

Sections 141 thru 144 – These sections cover the duties of the Health Choices Commissioner in ensuring that all plans are compliant. There is also a provision for a Health Insurance Ombudsman who will provide assistance and handle grievances for individuals.

The 150’s sections cover things like Whistleblower protection and prohibiting discrimination of health care plans.

section that seems to cause great alarm. I’m not sure why exactly. I mean, I’m not too keen on all my personal information out there in cyberspace but we have had electronic records for years now and so our information has been floating around out there for a long time.
Particularly rankling to many is:

‘‘(D) enable the real-time (or near real
time) determination of an individual’s financial
responsibility at the point of service and, to the
extent possible, prior to service, including
whether the individual is eligible for a specific
service with a specific physician at a specific fa
cility, which may include utilization of a ma
chine-readable health plan beneficiary identi
fication card;
‘‘(E) enable, where feasible, near real-time
adjudication of claims;
‘‘(F) provide for timely acknowledgment,
response, and status reporting applicable to any
electronic transaction deemed appropriate by
the Secretary;

Looking at this one section at a time: D is pretty much what happens now in larger medical facilities. If I needed to go to a specialist (when I had insurance) at the large metropolitan complex, they would take down my information, check my insurance and tell me what was covered, if the doctor was in my network and what my co-pay would be. Nothing too exciting or radical there.

For some reason there are people who want to read E and F together and come to the conclusion that the Secretary or some other government entity (read; devil) is going to dun their bank account.

But they are actually labeled separately. E has to do with adjudication, which generally means to settle a dispute. So, if taken by itself like it was written, I go to the doctor’s and they tell me my co-pay for a procedure will be $X but this is a preventative visit and there should be no co-pay so I protest. E says the provider or their employees should do what they can to resolve the issue as quickly as possible, preferable before I leave the office.

That leaves F. No where does F talk of obtaining funds. It addresses timely acknowledgement, response and staus reporting – regarding any electronic transaction deemed appropriate by the Secretary (of Health). This makes perfect sense if you have started reading from the beginning of this document, especially the entries describing how the Health Secretary will be responsible for establishing universal electronic standards.

Now if you add G and H which follow D,E and F in the document, it becomes a little clearer.

'(G) describe all data elements (such as
reason and remark codes) in unambiguous
terms, not permit optional fields, require that
data elements be either required or conditioned
upon set values in other fields, and prohibit ad
ditional conditions; and

‘‘(H) harmonize all common data elements
across administrative and clinical transaction

This brings me to page 60 of HR 3200, just 957 pages left!

AARP has an informative article with resource references HERE. Worth reading ~


  1. Ah, a little light summer reading.

  2. Rocky, you have more patience that Octopus, and I am not referring to the formidable size of the document. I refer to the bad faith behavior of our so-called conservative 'friends' who are reciting the same script as the town hall hooligans. Earlier today, I left these stats, properly attributed, under Pamela's post on healthcare:
    - - - - - - - - - - - - - - - - - -
    Health care costs and trends:

    FY 2008 - $2.8 trillion representing 17% of gross domestic product (compare with Switzerland = 10.9 % GDP, Germany = 9.7% GDP, Canada = 9.7% GDP, France = 9.5% GDP)

    Projections: $3.1 trillion by 2012 and $4.3 trillion by 2016; 20% GDP by 2017.

    Since 1999, employment-based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent during the same period.

    Medical Bills Underlie 60% of US Bankruptcies:

    Medical bills are involved in more than 60 percent of U.S. personal bankruptcies, an increase of 50 percent in just six years, U.S. researchers reported Thursday (…) More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.”
    - - - - - - - - - - - - - - - - - -
    Why bother having debate with them? They don't want to acknowledge the facts or admit the scope of the problem. Not one is willing to condemn the town hall hooliganism. It’s a liberal-socialist conspiracy, you know, notwithstanding the ritualistic name-calling and catch phrases they bring to every debate. I’m done!

  3. As of last night, the CNN crawl was still plugging Sarah Palin and her "death panel" blues; no discussion, just the endless repetition of the accusation which is "truth" in the making.

  4. It is an outrage how healthcare reform is being turned into another swift boat project and very depressing to see people buying into it.
    But in the words of Dylan Thomas, I have no intention of "going gentle into that good night" but will continue to "rage, rage against the dying of the light."
    And before that light dies, I WILL leave a record here of the truth.

  5. I guess I agree, but whatever I leave, it may be no more illuminating to posterity than a dinosaur footprint.

    I don't know if you have the line by line version of the bill -- the one that has a completely paranoid fabrication for every line -- but someone spent a lot of time making sure there was no accidental truth left in it, yet everyone I know is sending it to me without checking one fact and assuming that yes, it's true, Obama wants to kill your mother.

    There are other places, better countries, smarter people. If they won't see the truth, let them eat shit.

  6. Yep, I have all 1017 pages of it and I'm slogging through it, bit by bit and then summarizing what I'm reading. Anyone wants to challenge my take, they better do their homework - I'm doing mine.

  7. Rocky, I commend what you are trying to do. I've read many different views of this bill and I try to take everything in and then decide for MYSELF what I feel.

    What some people fail to realize is that we are all not "experts" in the health care industry nor lawyers and we read it and understand it the best we can. I don't claim to understand nor do I go around saying it says this or that. If Obama wanted people to actually UNDERSTAND it, then it should have been written out better. There is chaos and confusion and it is NOT the citizen's fault. Fancy, big words do not make it better just less understood. Maybe that was even intentional, because I can't think of any rational reason to explain why you would write something that you feel is so important, that could be so misinterpreted.

    Rocky, you are well read regarding the health care industry and I respect your views and opinions. Unfortunately you are the minority and to blame people (not speaking of you but in general) for not understanding this bill is arrogant and unfair. Even representatives ask "What's the point in reading it?" That is a very telling statement when those that are supposed to represent us, can't or won't read it.

    Then to assume that opposition to this could only be some agenda by republican "mobs" is beyond ridiculous! Maybe, we just don't like the bill? Maybe we think that it should be handled different? Of course not, its just easier to say that we are all following some right wing radio host. It gives us little credit and is in fact quite condescending.

    I may not have the education level as some others but to assume that we protest because we are told to is just wrong and offending.

    Octo, you say "They don't want to acknowledge the facts or admit the scope of the problem. Not one is willing to condemn the town hall hooliganism."

    The facts by who? There is SO much confusion, again, (not OUR fault), that it's difficult to know what on earth to believe. You give facts that support this bill because you like it. I read facts from others that don't support this bill and they are just as legit as yours. Do you really expect me to go to Obama's site and listen to his "facts." You honestly don't believe that they are completely impartial do you? I'm not that naive. You also say that we do not accept the scope of the problem. Again a bit arrogant to assume that because we don't like this bill then we don't understand the problem with the health care industry. I am living right smack in the middle of it in fact. I know how the system is NOT working for me. I don't have the luxury of looking at it from an outside view. I wish I did!

    Why should I condone real, legitimate citizens voicing their disapproval of this bill. I find it refreshing that people are standing up against something they dislike this much.

    With narrow minded views like this then I guess you are right, there really is nothing to debate. I'm very disappointed, I thought you saw us for who we are instead of painting us with a broad paintbrush like so many do. How can we accomplish anything when two sides stop trying to listen and understand the other side. I guess we don't and that is what holds us back from being productive.

    "so-called conservative 'friends'"
    Wow! Just wow!

  8. Jennifer, don't take this personally, but I would be less than candid to deny that I am angry at the town hall hooliganism whose purpose is to squelch an open and honest debate. When thugs resort to intimidation tactics, it reminds me of the brownshirt tactics that brought Nazis into power.

    And what you don't quite seem to fathom is where this is coming from, i.e. mainly Big Pharma and the health insurance thugs who are hellbent on keeping their profit monopolies. Then good decent middle-class folks sing their praises and read their scripts. Folks like you and I who are getting ripped off by the cartels trying to control this debate.

    I know this. Problem is, you have not yet realized how you are being cheated and then manipulated by these thugs. The problem is not government control of healthcare but private control by thugs who act like Mexican drug lords fomenting violence to keep the greedy franchises.

    I am angry that good folks get suckered into this ... folks like you and me.

  9. Jennifer, I intend to slog through this whole bill and I'm sure there will be things I don't like and when I find them, I'll say so.
    As far as the language it is written in; Capitol Hill is mostly lawyers so of course the bill like many other bills is a morass of legalese.
    I have no problem with people voicing their opinion and not liking something - but declaring that this bill kills old people and babies is so over the top and nothing but a lie meant to inflame and incite - there is no truth to it so there is no merit in supporting those who spread vicious lies.
    I can only surmise that they can't find anything really wrong with this bill so they are trying to kill it by making stuff up.
    Did it occur to you that these so called town hall protesters seem to follow the exact same theme as if they were rehearsed for this by someone who has a big stake in seeing the bill tank - like big pharma?
    The big pharmacos are running ads in NC for legislators they say support research which makes me wonder just how deep in the pockets of our elected officials they are.
    While the bill may be tough to get through, kind of like reading Shakespeare, you don't need a degree to understand it, just patience, concentration and maybe a dictionary.
    This subject is much too important not to read it. Otherwise all we are getting is faulty information from sometimes shady sources. I need affordable health insurance, so do alot of other people. What are we supposed to do, just lay down and die? Talk about killing people, perhaps Sarah Palin can address THAT issue.

  10. I don't agree with all the things being said regarding this bill, like you mentioned killing old people for instance. Those kind of statements do hurt the honest debate regarding this bill.

    I find the insurance companies to be a huge part of the problem regarding health care. That they don't want to see this bill go through is obvious. Maybe we are looking at it from two different sides but the people that I have talked to that have protested, did it out of genuine concern. I'm not saying that everyone there is genuine, but that is hard to prove from either side you are on. I can only go on what I've been told by friends that have gone.

    I realize it was written by lawyers but this bill is a bit too much by anyone's standards.

    "I need affordable health insurance, so do alot of other people. What are we supposed to do, just lay down and die? "

    Rocky, I understand more than most! This month I had to decide between my mortgage and my insurance coverage, it's not an easy position to be in. I am paying out my butt to go to a doctor that is FINALLY helping me because the insurance that I did have didn't cover it and to top it all off, my boys need the same care that insurance doesn't cover. I'm not saying that there isn't a huge problem, I just don't see this bill as the answer. On Truth's latest blog we've gotten into a good discussion of ideas of what else can be done. We all see the need for change we just don't agree what that change should be!

    I ask this in all sincerity....what exactly makes you think that the protesters are from insurance companies rather than genuine protesters?

  11. Thanks, Rocky, for this analysis of the bill.

    I don't presume to know what exactly is in the bill because I haven't read it thus far, and I have no plans to read it in its entirety. Almost nobody ever does, including the very people who write parts of these Tolstoy-novel-length monsters. But in order to protest or support something, one must first know at least basically what it is. Since most of the things I've heard against Obama Care on my television are obviously the cartoonish figments of addled or even psychotic imaginations (death panels, etc.), I give such utterances neither my respect nor even my serious attention. They cannot serve as the basis of intelligent dissent.

    Demanding utter clarity and misinterpretation-proof language will never get us anywhere. There is no such language on any complex matter, and I suspect that ALL bills are written in lawyer-talk. "Parties to the third part," and all that. That's just the way things roll in D.C. What's going to be important to all of us, whether we read the bill or not, is the basic understanding we are able to gather regarding what's to be done about key aspects of health care and access thereto.

    As far as I'm concerned, the bill can take up half a dozen library shelves of polysyllabic prolixity worthy of Shakespeare's most hilarious word-manglers, so long as it outlaws insurers canceling our policies for absurd non-reasons or denying us vital coverage when we need it most, and so long as it does something sensible about expanding coverage to many who cannot presently afford it and explains how at least part of that expansion is to be paid for by fair means. These changes would be major improvements.

    There has been much effort on the part of insurers and other concerns to gut all attempts to change how health care is accessed in this country. Individuals have a right to their views and are justified in being anxious about changes to health care access. But it would be naïve to suppose that we, as individuals, are driving what is going on here. Repugnant as it may be to admit it, money has power to shape the public's views, and it affects us all, to a greater or lesser extent.

    My take is that healthcare and access to it are ethical issues, matters of fundamental well-being and peace of mind. So let me just ask readers, even if you trust your private insurer based on recent experience, do you trust that they would stand by you if a serious health crisis were to strike you or someone you love? I honestly have never met anyone who I think would answer "yes" to that question. Even posing the question is unsettling because it forces us to confront what we REALLY believe or at least suspect about our health care-access arrangements. Our security in life, in this regard, is built upon a foundation of sand. That is precisely the sort of thing that simplistic polling questions never capture. But if it is so, then it is sensible that the least we should demand from the reform process is that these arrangements should be rendered less unstable and subject to the whims of those whose primary interest lies in taking our money rather than in caring for us. Leaving things as they now stand affords no chance of achieving that objective, so something has to give.

    It's time to make something good happen. Perhaps it doesn't even matter whether the people hooting and bellowing at town halls are doing it from their own "genuine" concern or whether they are consciously doing the bidding of self-interested others. The point is that they are not adding anything to the debate; they are disrupting the proceedings whereby we can with tolerable efficiency come to understand what should be done. That is destructive to the democratic process.

  12. What makes me think that the protesters are not genuine?

    I have watched tape from several of these town hall meetings and it is too staged, too similar.

    They follow the same script - shouting down the politician and then repeating the same objections in nearly the same language - like they all read it out of the same playbook.

    There are probably people genuinely concerned attending these meetings but there are those whose job it is to skillfully manipulate the meeting and I think the genuine people are getting lost.

    Personally, I would like to hear THOSE people's questions and concerns and I'd like to hear the answers from their legislators.

    But that's not what is happening is it? Watch the tapes - no meaningful exchange is being allowed to take place.

    I don't really trust the government much, haven't trusted them since they gunned down the students of Kent State. And I'm sure this healthcare bill has enough crap in it to really piss me off before I'm done reading it, but we have to start somewhere.

    You should not be choosing between your mortgage and your health insurance, others should not be dying because they can't afford cancer treatments, I am reasonably healthy and should be able to obtain reasonable insurance without pre-existing clauses.

    The government should be providing us with a clear plan we can all understand and a clear plan for how it will all be paid for.

    There are a lot of players who do not want us to react in a reasonable manner and start asking logical questions.

    What better way to derail the whole process than to spread ridiculous lies and cause chaos in every public forum.

  13. Once again, dino you have cut right to the heart of the matter. Dinosaurs rule! Even if it isn't perfect - we need change and we need it sooner, not later.
    And healthcare should not be something profitable but something ethical and accessible to all.
    Having worked in healthcare for so long, I have watched the decline in services and accessiblity while costs continually climbed.
    It is a big, monsterous thing and will probably need to be amended over and over as problems develop, but that should not stop us from moving forward - imagine if we had stopped pushing the space program because it was difficult and fraught with problems; man would have never walked on the moon.
    Is the health of our nation any less important?

  14. Jennifer: "I ask this in all sincerity....what exactly makes you think that the protesters are from insurance companies rather than genuine protesters?"

    I tried to answer this question in part under these two recent posts (scroll down):



    Some of these protesters are shills for the insurance industry. And some of them are merely misinformed ... like a lynch mob at the jail house door.

  15. The general public who are oblivious to HR 3200 need to know what it entails. The actuality of it needs to get out so it can be heard. People need to be informed, and they need to know what is actually going on with this bill. Go to to get a free PDF download of the bill, or you can purchase a printed and binded hard copy of the bill.


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