Back to Basics

The health care industry has problems, just like the auto industry.  But using government funds to bail out and take over another industry is not the answer.  The government has already failed in running Social Security and Medicare, with both programs going broke.  With a history of failure, why would another government run health care program succeed?  It wouldn’t.

The government program may provide INSURANCE for everyone, but having insurance does not necessarily mean you have access to care, nor does it guarantee the quality of care you get.  The government program by many speculations will result in rationing of care due to an insufficient number of doctors, nurses and other medical professionals.  It will also result in longer waiting times to get an appointment.  In many cases that could mean the difference of life or death, of treatment that saves money in the long term, of preventing permanent disabilities or surgeries.  Being able to obtain quality care in a timely manner is of utmost importance.  We cannot sacrifice that care for a government system.

People talk about the disparity of health care.  If H.R 3200 or a similar program is passed, the disparity will only increase.  The 15% of people who are currently uninsured may become insured, but projections are there will still remain a majority of these people who will be uninsured.  There will be a greater number of people whose current coverage and care will actually decrease in quality.  As companies determine if the 8% penalty outweighs the cost they contribute to employer-based health care policies, they may opt to pay the penalty and leave the employees to fend for themselves.  Smaller companies may still not be able to afford the health care coverage or the penalty and may close down, leaving those employees unemployed and looking for work in a grave economy.  For anyone who has been a small business owner (and I have), unless you have many financial resources, just paying the daily bills is a challenge, often with the owner living off what little is left.  Small business in America could quickly disappear with more government mandates.  One can only speculate how the business world will react and the consequences this will play for health insurance for the employees.

A small group of people won’t be affected by the program either way.  These are the people with money.  They will have their insurance plans, but most important, they will also have the resources to pay for care out of their own pocket.  They will have the ability to go where they want to receive care because they will have the resources to pay for it.  Granted, they have that option now.  But with the prospect of rationing, having the cash to pay for service may be a determining factor in actually receiving quality care in a timely manner.

The answer is not forcing the people on plans they don’t want, especially when 85% of the people are happy with their current coverage.  Why is 15% of the population going to destroy it for the rest?  Penalties and taxes is not the way to fix the problem.  The PEOPLE are not the problem – the insurance companies, medical system and drug industry is the problem.  The reform should start with them, evaluating what changes can be made with those industries without hurting the people.  Don’t punish the people when the industry is corrupt.

Under the title of Public Health & Workforce Development are a number of grants, scholarships and other programs, providing training, services and a whole new array of studies relating to health care – a lot of money being spent to support the expansion of government, special interests, illegal immigrants and labor unions, but little to help solve the health care issues.

The first expansion is the establishment of the Public Health Investment Fund, which requires deposits from the revenues of the Treasury in the amount of $88,700,000,000 over 10 years. This money is authorized to be appropriated by the Committee on Appropriations of the House and Senate for carrying out the activities under the designated public health provisions. These areas include Community Health Centers, National Health Service Corps Program, National Health Service Corps Scholarship and Loan Repayment Programs, Primary Care Loan Funds, Primary Care Education Programs, Nursing Workforce Development, The National Center for Health Statistics and the Agency For Healthcare Research and Quality.

To make these programs even more appealing is the stipulation that “Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget solutions for fiscal years during which appropriations are made from the fund.” More spending without any concern for balancing the budget or controlling the country’s deficit. We don’t have it, but let’s spend it!

The first program – Community Health Centers – will obtain increased funding in the amount of $38,800,000,000.

The National Health Service Corps is being amended allowing the Secretary to issue waivers to individuals who enter into a contract for obligated service to pay for their education. It further raises the loan repayment amount from $35,000 to $50,000 and will be adjusted thereafter to reflect inflation. Additional appropriated funds for this program are $796,000,000 over the next 10 years. Additional funding is authorized in the amount of $3,171,000,000 over 10 years to cover the National Health Corps Scholarship and Loan Repayment Programs.

The Frontline Health Providers Loan Repayment Program will be established to address unmet health care needs in certain areas, populations, or facilities as designated by the Secretary. Individuals participating in this program must agree to serve for a period of 2 years in a health professional needs area specified in the program. This program has a clause that if there are an insufficient number of applicants for the program, then all excess funds from the program will be transferred to the National Health Service Corps to recruit more people to take advantage of this fund.

The Secretary shall establish a primary care training and capacity building program consisting of grants and contracts to plan, develop, operate or participate in accredited professional training in the field of family medicine, general internal medicine, general pediatrics or geriatrics. Funds for this program are from the Public Health Investment Fund in the amount of $3,023,000,000 for 10 years and will include the following:

• Capacity Building in Primary Care – grants to specialties of family medicine, general internal medicine, general pediatrics or geriatrics, with preference given to entities that train individuals who are from underrepresented minority groups or disadvantaged backgrounds.
• Training of Medical Residents in Community-Based Setting – a program established for the training of medical residents in community-based settings, with preferences given to entities that support teaching programs addressing the health care needs of vulnerable populations or are a Federally qualified health center or rural health clinic, as well as preference to those training individuals from underrepresented minority groups or disadvantaged background.

• Training for General, Pediatric or Public Health Dentists and Dental Hygienists – grants and contracts to plan, develop, operate or participate in an accredited professional training program or oral health professionals, with preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.

Grants for Health Professionals Education – Advanced Education Nursing Grants is being amended, including increases in dollar amounts for the Nurse Faculty Loan Program. Funding for this program is $1, 450,000,000 over 10 years.

The Public Health Workforce Corps is being amended and expanded by the following: Creating the Public Health Workforce Scholarship Program, Public Health Workforce Loan Repayment Program, Enhancing the Public Health Workforce, and Preventive Medicine and Public Health Training Grant Program. Appropriations for these programs total $642,000,000 over 10 years. The Enhancing the Public Health Workforce even includes provisions for veterinary medicine! I’m not sure how veterinarians will provide quality health care to people or decrease health care costs, but it’s nice to see even our animals will be included in the grant programs.

Under the Subtitle “Adapting Workforce to Evolving Health System Needs” there are a number of grants and programs including:

• Health Professionals Training for Diversity, which includes scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistant in health professions regarding individuals from disadvantaged background.

• The Nursing Workforce Diversity Grants is being amended and adding the Coordination of Diversity and Cultural Competency Programs.

• The Secretary will establish a cultural and linguistic competency training program for health care professionals, including nurses, consisting of grants and contracts to develop and implement models of cultural and linguistic competency training. Preference will be given to entities that address cultural and linguistic needs of the population and health disparities, and placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border. Obviously this program will benefit all the illegal immigrants coming from Mexico to obtain free health care.

Appropriations for these programs total $1,138,000,000 over 10 years.

Grants and contracts are given to develop training programs to promote the delivery of health services through interdisciplinary and team-based models, with preferences given to entities that demonstrated training to the greatest number of health professionals who serve in underserved communities.

As I initially read and took notes throughout this section I really didn’t grasp the absurdity of the program.  When I started writing this column I was overwhelmed by the stupidity of the thought that someone would actually think this was health care reform and not just a government take over of the health industry.  The public option is based on the same business model (if you could actually call it that) of the Medicare system – the system that is currently failing and going bankrupt today!  So why would one think that applying the same standards of a failing business to another model is going to create success.  Did any of the members participating in the creation of this bill have any business background?  Failure x 2 does not equal success.  With that said, I will continue on my quest at reporting on bill H.R. 3200.

The Public Health option is the portion of the bill allowing the government to sell insurance.  The Public Option is basically a Medicare type program offered to those who do not quality for Medicare, operating concurrently and competing against the private plans offered in the Health Insurance Exchange.  The government controls the Health Insurance Exchange, controls the policies offered within the exchange, and would now be able to sell government policies.  Try side stepping this all you want, but this is a government take over of health care.

Some of the bill’s BS (sorry) just could not be reworded or interpreted, so I had to quote the bill so you could fully understand the vague references and enthusiastic goals of the Public Option.

The Magic Wand of Health Care

The bill establishes the administration of a Public Health Insurance Option, an exchange qualified plan, which is supposed to “ensure choice, competition and stability of affordable, high quality coverage.”  The Secretary of Health & Human Services is responsible to create a “low-cost plan without compromising quality or access to care.”  WOW!  Apparently the magic formula has been discovered to have low-cost insurance premiums that will give accessible and quality care, and if you listen to Obama’s promises, this will not raise taxes.  Since this is similar to Medicare, one would have to wonder why this magic wand hasn’t already been applied to Medicare to ensure the same quality of care without bankrupting the system.

The Public Option will only be made available through the Health Insurance Exchange, so if you cannot obtain insurance through the exchange for whatever reason, you will also not be able to obtain the Public Option insurance either.  (For further information, please visit article H.R. 3200 – The Health Insurance Exchange.)

The Public Option must comply with the requirements that apply to an exchange plan, including benefits, benefit levels, provider networks, notices, consumer protections and cost-sharing.  Different levels of plans will also be offered.  The Secretary enters into the contracts for the public option.  This is similar to that of the Commissioner on the Health Insurance Exchange.

The Secretary sets the premiums for the public option and may allow for geographic adjustments.  The rates must be set at a level sufficient to fully finance the cost of the health benefits provided by the public options and all administrative costs related to operating the public option.

The Secretary will determine the payment rates for services and providers based on similar services and providers under Parts A and B of Medicare.  Since this public option includes services typically not provided under Medicare (such as well-child visits) the Secretary has the ability to modify payment rates to accommodate these services.  The same goes for prescription drugs not typically covered under Medicare Part A or B.

An incentive is offered to get providers to participate, allowing rates 5% greater for the first three years.  Anyone on Medicare knows how difficult it is to find a doctor that will accept patients under Medicare – they just don’t want to get involved with the government program.  So to try to get doctors to even participate in this new Public Option plan, they will allow them to charge more for services just to get them to sign up.  The catch – but only if they participate in both Medicare and the Public Option.  Pediatricians and other practitioners who typically do not participate in Medicare would also be eligible for increased payment rates.

Our nation’s health care system affects every aspect of American life and every component of our nation’s economy, accounting for approximately a sixth of our nation’s Gross Domestic Product. Also, as you are likely aware, health care spending has risen dramatically in recent years, far outpacing inflation, leaving countless families with difficult decisions about providing care for loved ones. Even Medicare, the vital safety net program for 45 million seniors and disabled individuals, is facing fiscal insolvency and higher out of pocket costs for beneficiaries.

This is simply unsustainable. Health care costs are rising and, if left unaddressed, will undermine Medicare and private insurance. Private insurance currently covers about two-thirds of all Americans and if these programs are undermined or eliminated, it could potentially add to the 48 million Americans currently without any form of health insurance. While the prospects of health care reform are daunting, it must be done, but done right, and in a truly bipartisan fashion.

I believe that there are four pillars that should help guide reform: affordability, portability, access, and quality. No one piece is more important than another, but taken together, I believe that we can create a health care system that can provide affordable, quality health care coverage for all Americans.

Our reform efforts should create a system that enables people to access affordable health coverage that includes high quality health care. Americans want to be able to choose their doctors, coverage, and care, and to have the freedom to seek employment that is not dependent on whether or not insurance coverage is provided. I believe that we can reform the current system to achieve this goal without turning to a government-run plan which would lead to rationed care, creating delays in treatment and eliminating consumer choice.

An increasing amount of our health care dollars and resources are directed towards treating chronic conditions such as heart disease and obesity. Therefore, any new reform must also encourage prevention initiatives that work. Medicare and Medicaid payment systems must also be reformed to promote prevention.

In addition to improving medical care and reducing costs, I believe our health care system should use health information technology to improve efficiency and quality in health care, and that we should find ways to reduce the number of medical malpractice lawsuits, which drive up the cost of health care and make coverage more expensive.

During the recent mark-up of the Senate Health, Education, Labor and Pensions Committee’s health reform bill, I supported an amendment which would prevent health care providers from being required to participate in abortions if doing so would violate their personal moral and ethical convictions. As you may know, I have consistently opposed measures which encourage or lead to more abortions, including the use of any federal funding for abortions.

I was also a strong proponent of an amendment that would have required Members of Congress to participate in the proposed public health plan if one is enacted into law. If the health care reform legislation that is being considered becomes law, it would force millions of people to give up their current forms of health care coverage and participate in the government run program. I believe that Members of Congress cannot expect these individuals to participate in this new public program if they are not willing to enroll themselves and their families in the same program.

On Wednesday, July 15, 2009, the Senate Health, Education, Labor and Pensions Committee approved the Affordable Health Choices Act on a party line vote of 13-10. I voted against the legislation because it does little to actually lower health care costs and still leaves 34 million people uninsured. The actual final cost of this legislation to our country and its taxpayers is still undetermined, but the Congressional Budget Office has stated that the bill substantially expands federal responsibility for health care costs without addressing the critical changes necessary to reduce the anticipated federal health spending. While I understand the need for reform and will continue to support meaningful measures that will lower costs, improve access to quality health care and expand coverage, I cannot support this bill in its current form because it spends too much, taxes too much, leaves too many people uninsured and does nothing to drive down health care costs.

Again, thank you for sharing your views on this important issue. Please be assured that I will continue to keep them in mind as Congress considers legislation to reform our nation’s health care system. Feel free to contact me on this or any other matter.

Sincerely,

John McCain

United States Senator