Washington's prescription

Had a chance yet to read the House healthcare bill? At just 1,017 its prescription for how to cure the nation's medical ills is only 198 pages shorter than the latest edition of Tolstoy's masterpiece War and Peace.

While there likely will continue to be more war than peace when it comes to congressional debates over the controversial bill, actually reading line by line through its 2,541 sections is a slog akin to having to read the phone book. Just ask 180 House Democrats who last week attended a five-hour seminar in the Capitol basement. Leaders organized the staff-led tutorial so lawmakers could defend against accusations of not having read the bill. Lawmakers emerged from the closed-door session declaring that they are now armed to answer constituent questions during the month-long August recess. Alas, word soon leaked that the lawmakers were aided in the discussion by a 34-page summary of the bill.

In case you need to do your own homework in advance of your lawmakers coming to town, below is WORLD's own summary of what appears to be in store for the country if HR 3200, "America's Affordable Health Choices Act," becomes law: • The government will audit your books if you self-insure: The newly created Commissioner will submit a report to the government that includes "any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure." (21.23-23.3) • The government will define your "health benefits": "[Establish] a private-public advisory committee . . . of medical and other experts to be known as the Health Benefits Advisory Committee" to recommend what will be in the "covered benefits" and what are "essential, enhanced, and premium plans." (30.13-30.18) • The government will ration your care: Establish an annual limitation on cost sharing to ensure that "the cost-sharing incurred . . . with respect to an individual (or family) for a year does not exceed the applicable level specified--$5,000 for an individual and $10,000 for a family." (29.4-29.16) • The government will establish and administer a public health insurance option: "The Secretary's primary responsibility is to create a low-cost plan without compromising quality or access to care." (page 116, lines 1-17) • The government will define how doctors manage their time: "The Secretary shall establish a process" to assign value units to "components and elements" of a doctor's health care work, basing the relative value on "time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk." (page 253, lines 10-18) • The government will tax employers for not providing healthcare: If an employer does not provide health insurance coverage, a contribution "shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund." The rate will be 8 percent for a large employer payroll (over $400,000), 6 percent and lower for a small employer payroll. (page 149, line 14--page 151, line 5) • The government will tax individuals unless you are a foreign resident: "Tax on individuals without acceptable health care coverage...imposed tax equal to 2.5 percent of the [gross income]." (page 167, line 17--page 168, line 4) This "shall not apply to any individual who is a non-resident alien." (page 170, lines 1-3) • The government will order you to get end-of-life counseling and show proof: "[An ] advance care planning consultation between the individual and a practitioner . . . [is required if] the individual involved has not had such a consultation within the last 5 years," including an explanation by the practitioner of "end-of-life services." (page 424, line 20--page 425, line 23) "A consultation . . . may include the formulation of an order regarding life sustaining treatment or a similar order," including end-of-life services. (page 429, lines 1-3). "Orders regarding life sustaining treatment," including "end of life" directions, can be signed either by a physician or "a nurse practitioner or physician's assistant who has the authority under State law." (page 429, line 8-16) • The government will limit your hospital readmissions by penalizing hospitals: "The Secretary shall reduce the payments" to any hospital with "excess re-admissions," based upon a ranking of hospitals by a national readmission ratio to be developed by the Secretary. (280.10-288.22) The Secretary "shall conduct a study to determine how the readmissions policy described in the previous subsections could be applied to physicians . . . [including] a payment reduction for physicians who treat the patient during the initial admission that results in a readmission." (page 297, line 17--page 298, line 14) • The government will restrict coverage of special needs patients: Restrict enrollment of new "special needs plans" within Social Security, beginning January 1, 2011, and "the Secretary shall submit to Congress a report" on recommendations regarding the treatment of existing plans, "as the Secretary deems appropriate." (page 353, line 13--page 355, line 6) • The government will not let you sue over coverage limits and costs decisions: "There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224." (page 124, line 4--page 125, line 2) • The government will mandate what physicians make: The Secretary "shall provide for" physician participation under the public health insurance option, "for which payment may be made for services furnished during the year. . . ." (page 127, lines 1-16) • The government will have access to your bank accounts: "Require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part." (page 59, line 21--page 60, line 8) • The government will not call the fees it imposes taxes: "The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55." (page 203, lines 13-18) • The government will issue you a health ID card: "include utilization of a machine-readable health plan beneficiary identification card." (page 58, lines 5-13) • The government will enlist or create outreach programs like ACORN to sign-up individuals to government-run plan: "The Commissioner shall conduct outreach activities . . . for enrollments in Exchange-participating health benefits plans . . . through means such as the mail, by telephone, electronically, and in person." (page 95, line 3--page 96, line 9) • The government will create a new bureaucracy to include phone healthcare: "The Secretary shall appoint a Telehealth Advisory Committee to make recommendations to the Secretary on policies of the Centers for Medicare & Medicaid Services regarding telehealth services. . . ." (page 379, line 8--page 380, line 14) The Bill To read HR 3200 in its entirety, click here to download a pdf of the bill.