“Max Tax” (Baucus bill) hurtling through Congress
Saturday, September 26, 2009 at 2:49PM Transparency having become an early casualty in the process of driving through “health care reform” despite rising opposition, the Senate Finance Committee chaired by Max Baucus (D-MT) is marking up a shell bill, a 200+ page outline.
Some think the strategy is to take the product, merge it with the product of the Senate Health, Labor & Pensions (HELP) Committee, and tack it on as an amendment to a bill imposing a tax on certain recipients of bailout funds. Conceivably, the transformational change of one-sixth of the economy could be enacted in two weeks (The Foundry, Heritage Foundation 9/22/09). Then the bureaucrats could set to work on the 100,000+ pages of regulations.
Senator Baucus called the proposal “one of the largest pieces of social legislation since the Depression.”
The individual mandate would force every American to buy approved insurance, or face an IRS-enforced penalty of up to $3,800 per family, writes Linda Halderman, M.D. (American Thinker 9/17/09). Or perhaps it would be only $1,900, since the Committee accepted amendments by Sen. Schumer (D-NY) and Sen. Snowe (R-ME).
Baucus proposed a new payroll tax of $400 per worker not provided with generous health benefits. Along with a 35% tax on too-generous health coverage exceeding $8,000 per year, with the $8,000 limit to include flexible savings accounts (cafeteria plans).
His $856 billion proposal would protect Medicare, Baucus said at a press conference. Then he said that financing would come partly from eliminating Medicare Advantage payments, noted Dr. Halderman.
Baucus had urged the Centers for Medicare and Medicaid Services (CMS) to look into “scare tactics” by Humana, which was informing its beneficiaries that they could lose their Medicare Advantage benefits. The Wall Street Journal called it “bullying tactics,” America’s Health Insurance Plans called the CMS action a “gag order,” and even AARP called it a “selective and inappropriate use of its regulatory powers” (NY Times 9/22/09).
The Humana mailing was “misleading and confusing to beneficiaries, who may believe that it represents official information about the Medicare Advantage program,” said Jonathan Blum, acting director of a CMS regulatory office, and former senior aide to Sen. Baucus. CMS is not investigating AARP for its political advocacy. On its website, AARP states as “fact” that “none of the health care reform proposals being considered by Congress will cut Medicare benefits or increase your out of pocket costs” (Wall St J 9/24/09)
The Baucus bill was stripped of a few of the most contentious elements in an effort to attract Republican support: the “public option,” an employer mandate, and Medicare payments for counseling seniors about “end-of life care.” The Congressional Budget Office (CBO) estimated a 10-year cost of $774 billion, and estimated it would cover 94% of “Americans” by 2019, leaving 25 million people—one-third of them illegal aliens—without coverage., writes John Iglehart (N Engl J Med 9/24/09).
Lacking initial support, it is proceeding along “the sort of winding path often followed by major legislative initiatives,” writes Iglehart.
Initial CBO analysis says the Baucus bill would not add to the deficit because its costs would be covered by a tax on “Cadillac” insurance plans, a slowing of the growth of Medicare and Medicaid payments to nonphysicians, and new fees on clinical laboratories and medical-device manufacturers.
Insurers would be required to cover everyone without discrimination on the basis of health status or caps on annual or lifetime coverage.
John Goodman notes the following effects in an article entitled “Baucus Declares War on the Middle Class”:
- The threshold for the 35% excise tax on “Cadillac” insurance is indexed to the consumer price index (CPI), not the medical price index (MPI), which grows three times as fast. Eventually, all insurance will exceed the cap and be taxed.
- “Credible” employer coverage might cost $13,000 for a family. The maximum the employee can be required to pay is 13% of income, or $6,500 if income is $50,000. The employer must pay the rest (out of reduced wages). The full cost that must be paid by workers, either in premiums or reduced wages, after adjusting for taxes, amounts to 26% of his income.
- If the worker qualifies for Medicaid, the employer faces no increased costs. Thus, there is an incentive to hire the poor, and not to hire the middle class.
- Millions of families will be forced to move from private plans, which provide a broad choice of physicians, to Medicaid and S-CHIP plans with much more limited access.
David McKalip, M.D., notes the following effects on physicians, from the version of the bill available to him:
- Capitation will become the dominant mode of payment.
- Doctors would have to be a “Medicare-enrolled physician” to order services that would result in any cost to the Medicare program.
- Doctors will be penalized for going over budget, and no statistically valid samples will be used. At the same time, the cost of procedures and devices they order will be driven up by taxes.
- Doctors will be made to pay $350 each into a fund to pay for “screening” programs to cover unannounced and random site visits to check for “waste, fraud, and abuse.” Doctors may be prevented from practicing in a “fraud-prone” specialty, or required to put up a $500,000 surety bond.
- Medicare funds are redistributed from specialists to primary-care physicians.
Estimates of the effects of “health care reform” bills ignore the effects of other pending legislation, such as the Waxman “cap and trade” bill. Higher unemployment caused by this bill would increase the number of uninsured. The Kaiser Family Foundation estimates that for every percentage point increase in unemployment (the loss of 1.54 million jobs), the number without health insurance rises by 1.1 million. Using projected job loss figures from Heritage, this could mean more than 820,000 losing their health insurance annually. New health problems are also highly correlated with job loss—including hypertension, heart disease, diabetes, alcohol-related problems, and low birth-weight babies (National Center for Public Policy Research, September 2009).
Although Democrats may be staking everything on passage, Iglehart notes: “The reform effort could be derailed at any point along this treacherous path, and the future of Obama’s presidency could hinge on the outcome.
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Reader Comments (14)
Please do everything you can to lobby against this and all legislation like this in the name of God and our constitution.Don't let this country be led into a socialistic state.
Best regards,
Larry Meadows
Wow, this is very, very scary. I noticed one provision that really bothers me: doctors will be required to be a medicare enrolled physician in order to order services covered under medicare. Medicare patients have been taxed all their life and are forced into a program that puts them at the bottom of the priority list. They can get around this by going to doctors who have opted out of medicare...indeed, this may be the only way they can get timely care. What about labs and x-rays and MRIs and so forth? They may be able to afford to pay the doctor, but these tests can run into the thousands...this will mean that seniors who aren't independently wealthy but who can afford to pay their own doctor won't have that choice. They'll be forced back into the medicare cattle truck. This is a very sad day for America.
WHAT DON'T YOU DEMOCRATS UNDERSTAND ABOUT "THE AMERICAN PEOPLE DO NOT WANT YOU MESSING WITH OUR HEALTH INSURANCE." WE ARE HAPPY WITH WHAT WE HAVE, JUST LET US BUY OVER STATE LINES. TAKE CONTROL OF LAWYERS THAT USE OUR DOCTORS. LEAVE DOCTOR PATIENT ALONE. TAKE CARE OF CREATING JOBS FOR THE AMERICAN PEOPLE. HOW ARE THE AMERICAN PEOPLE GOING TO AFFORD YOUR INSURANCE COSTS WHEN THE MAJORITY OF THEM DON'T HAVE A JOB???????? GIVE UP ON OUR HEALTH CARE AND TAKE CARE OF THE BUSINESS OF RUNNING THE UNITED STATES AND OUR SECURITY. BEGINNING WITH THE CALIFORNIA FARMERS THAT NEED THEIR WATER TO GROW FRUITS AND VEGETABLES THAT FEED THE U.S. I HOPE YOU CONGRESSMEN GET THE FIRST SHIPMENT OF LETTUCE FROM CHINA!!!!!! WE CARE MORE ABOUT THE FARMERS THAT ARE STANDING IN LINE FOR SIX HOURS FOR FOOD THAN WE DO THE 3 INCH SMELT!!!!!! GET TO WORK ON WHAT NEEDS TO BE TAKEN CARE OF FIRST. YOU REPRESENT US AND WE PAY YOUR SALARY. WE DON'T WORK FOR YOU. I HOPE YOU WILL TAKE NOTE OF THAT.
I'm wondering who, if ANYONE, understands this issue. They've made it all so confusing, I don't know what to be for or against! Obfuscation could even be the goal? The last thing I want is health insurance that only covers conventional treatments. Health itself is the issue, not to be confused with our current health"care" system, which is thoroughly broken. Money should be spent on educating people about how to maintain health, not on the eat all the twinkies you want and reincarnate in front of the boob tube people who head for the doctor once a week for the latest pill just advertised and all the consequential sloth-related symptom management. I don't use allopathic medicine, won't use it unless I break a bone. Why should I be FORCED to buy something I have no faith in and I won't use? This is fascism at it's worst and insanity at best. May a higher intelligence save us from our "protectors"!
I can not believe we pay people to sit in the house and senate who rack their brains to come up with something the American people have already told them we do not want any part of (healthcare reform)! What we do need is Government Reform-reform that allows citizens to have some voice!
What do the President and Congress care-they're covered, very nicely, for life11
THEY HAVEN'T SHOWN ME MUCH-vacations and retreats etc. etc.
It's nice to be young and want to change the world-but you had better listen to experience and study up on what principals THIS COUNTRY is based on. Kathy Sweeney
Do those of you in the Senate and the House realize what you are doing to your children and their children. They won't be eligible for the health care you will be securing for yourselves?
How do you plan to deal with insurance for federal employees and federal retirees? Will they continue with the plans they now have or will they to be put in the cattle car?
I sometimes feel our House and senate are taking the roles of the Judas Goat.
No more taxes- No more socialistic government interference in our lives-No more European style health care threats.
Correct the few things wrong with what we have and then leave us alone. Open up health care programs across state lines, correct unreasonable law suits, and make the uninsurable insurable and the leave it alone.
When is congress and the rest of them going to listen to the people, they do not want our health care changed. they want it fixed certainly but this is ridiculus and why the rush another Obama strategy to get what he wants and have us all on the government dole, Look the the outcry from the people you jerks work for us. None of you will be voted in again if this passes.
Health care reform is all about money. Without funding it will not be possible
to provide health care for all Americans.
Funding has to be huge and fair to all citizens. It requires a radical but
simple solution and difficult to implement because of the politics of self
interest groups. Just as it is simple to inform an obese patient that eating
less and exercising more is the answer to weight loss the patient finds it
difficult or impossible to implement. At least 70% of chronic health care
problems in the USA are a result of unhealthy lifestyles leading to tobacco and
obesity related diseases. A successful precedent has been set for taxing tobacco
resulting in decline of smoking addiction and secondary health conditions The
taxes from tobacco, alcohol along with new federal taxes on unhealthy
fats,sugars and fructose in foods and beverages should pay for health care
exclusively.
The logistics of at what stage of food processing the tax should be imposed can
be decided by economic experts challenge grass root constituents across the
country along with medical professional organizations like ACP and AMA to
request that their legislators begin to consider taxing all foods and beverages
like chips, french fries, red meat, sodas. while subsidizing healthy foods like
whole grains, fruits, vegetables, olive oil, fish,nuts etc.
This will not only pay for the health care of every American but assist in
motivating some to eat healthier at a lower cost.
I have a proposal for PCP comprehensive reimbursment that would compensate physicians who coordinate, promote and maintain health of patients and care for acute and chronic care in novel ways. Using some of the DRG model for each and every chronic health care problem a per member per month fee would be payed at an agreed upon appropriate rate. There would be no payment for telephone, face to face visits, coordination of care with specialists or review of lab,imaging,consultation reports of communication with family,nursing or social work providers for each patient.
For all new acute or chronic problems that develop the current fee for service payment would be payed until coded as a chronic problem.
Bonuses for performance determined by clinical outcomes for chronic disease with secondary fiscal benefits of efficiency and value will be rewarded as further incentive to practice high quality preventive medicine and health maintainence of chronic disease. Using such data as A1C, ldl, improvement in microalbumenuria, and many others pay for performance can be implemented.
This could be an alternative approach to the medical home model or even a compliment to it.
If you are serious about a solution to pay for health care and promote health get behind this and fight the food lobby.
God deliver us from all liberals!
What doesn't Congress understand? We as Americans "Do Not Want Government Controlled Health Care". Unfortunately we voted them in or not and they REFUSE to listen to the people What are we chopped liver? That is how they review us.
DC knows that to start with elminating the fraud in health care, letting us buy health care across state lines and limiting the awards on trail lawyers that would be the first start before passing a bill that is not even written yet? And they want to vote on it??????
We as Americans are being led like sheep over a cliff and we cannot let our guard down and we MUST continue challenging DC.
And Obama does LIE. In fact the majority of our government LIES. And that is a word that can only describe a LIAR, their own agenda is their only concern.
Vote them out 2010 and definately in 2012.
Republicans get it together NOW
Open up health care programs across state lines, correct unreasonable law suits, and make the uninsurable insurable, buy commercial insurance for the unemployed, and that's my plan, so don't say I don't have one.
And the bama did lie about the illegal immegrants: He is enough of a constitutional professor to know that even if this law indicates illegal immegrants can not be part of the single payer system, the court will shoot it down.
the future i go to my doctor and say doc my arm hurts when i do this he says do not do that
Hey thanks for the show and especially for the information, I really like it. Great work, keep going!
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