What Are the Hidden Costs of the Health Care Reform Bill?

I am not against reform of the Health Care Industry. There have been ideas proposed on both side of the political debate that seem workable to me. However, it seems that the debate has locked out the voices of a good many Americans to concentrate on a political solution rather than to find the best possible course of action. This lack of debate, secrecy (weren't we promised transparency) and use of "smoke and mirrors" causes me serious concern. I am one of those fools that actually read HR 3200, the first comprehensive legislation that was released to the public. Although the Bill that emerges may be substantially different from HR 3200, there were elements in that proposal that cause me serious concerns.

Aside from what is contained in the final legislation, one thing is certain. The shape that this Bil is taking fails to address all of the issues, some of them substantial, and contains hidden costs that we cannot even begin to calculate. My biggest question for my elected officials is why the secrecy? If this Bill is supposed to be good for America, why aren't Americans being included in the process. I understand the concept of not seeing how the sausage is made, but this isn't sausage. So, What will this Bill end up costing us?

The Financial Cost
When I was a young Marine, my Commander-in-Chief at the time, Ronald Reagan, pulled a budgetary fast one. That was a time when Gramm-Rudman Act was scaling back costs in the military and everyone was feeling the pinch. In a budgetary move that still amazes me, the President pushed the military payday back one day. From the end of the month to the first of the month. It moved the pay day from September 30 to October 1, effectively transferring the entire military payroll for one pay period into future fiscal years. Did we save the billions that it looked like we saved on paper? No. It was all smoke and mirrors. But is sure looked like visible savings.

I present that example to demonstrate that this opinion is not meant to be partisan or blind allegiance to a political party or ideology. It is also presented to show how costs are so easily hidden to make it look like a Bill is Budget Neutral. It is not a hard thing to do. This Bill claims to save money, but the first problem is that the Bill collects taxes for several years before it starts spending them. The Bill also uses estimates provided by the Congressional Budget Office, which is a non-partisan entity that has a history of under-estimating costs. How do you calculate what the effect of adding a chunk of new patients to the health care system without adding providers on cost? A simple supply and demand model would suggest that the cost will increase...possibly substantial increases. That is not factored into these numbers. The CBO also "double-counted" the savings generated from Medicare spending stating:

"The key point is that the savings to the HI trust fund under the PPACA would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. Trust fund accounting shows the magnitude of the savings within the trust fund, and those savings indeed improve the solvency of that fund; however, that accounting ignores the burden that would be faced by the rest of the government later in redeeming the bonds held by the trust fund. Unified budget accounting shows that the majority of the HI trust fund savings would be used to pay for other spending under the PPACA and would not enhance the ability of the government to redeem the bonds credited to the trust fund to pay for future Medicare benefits. To describe the full amount of HI trust fund savings as both improving the government's ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government's fiscal position." Taken from the CBO website at http://www.cbo.gov/ftpdocs/108xx/doc10868/12-23-Trust_Fund_Accounting.pdf

Another issue I have with Congressional Smoke and Mirror tactics like unfunded mandates. Anyone familiar with the debate on George Bush's No Child Left Behind understands that much of the flak on that legislation resulted from funding issues. When the Government enacts spending related regulations that cost each State money, that is an unfunded mandate. I do not have figures, but I know a little bit about how legislation works. Some of the cost of this Bill will come in the form of Unfunded Mandates that create a liability for the States. To demonstrate that there WILL be costs you need to look no further than Nebraska. The special deal struck with Nebraska's Senator to get him to sign on to the Senate deal was to prevent the costs being generated to the States from this Bill from being levied on Nebraskans. There is a fundamental Constitutional issue in that deal that is a separate issue. The fact that there are new costs should set off the bells and whistles. States are going to shoulder some of this burden, which makes it NOT budget neutral. I hate to even imagine what it is going to cost eventually.

Another trick that Congress uses with spending Bills is to reduce spending by cutting unpopular or expensive programs. After the dust has settled and no one is paying attention anymore, they reconvene and enact a "fix." Remember the "Doctor Fix" where 210 Billion dollars that was trimmed from the budget was added back in the House of Representatives? Luckily, the Senate left it out of their Bill. But that is how the sausage is made. Is the House going to try and put it back in during Conference? Who knows...but it is one small example of the dirty tricks used to hide the real cost of this monstrosity.

I am in an income bracket that puts me right on the bubble with tax increases. I am far below the thresholds that Obama set during his campaign, but I have already started to feel the pinch. With the current Bill (the latest Senate version) my income is right on the edge of triggering a .9 percent increase on my payroll tax for Medicare. That is a hefty fine for no explicable reason. It was also part of the back room wink and nod with Senator Ben Wilson. Another tax included in the bill was ten percent tax on tanning booths. Selective taxing seems unfair and un-American. People who live in colder States will have to pay to maintain their tan during Winter (I do not tan, so this does not affect me. But it doesn't make it right). The argument would be that tanning causes cancer, costing the system more money. The rebuttal would be that people in warmer states spend more time in the actual sun, which also causes cancer, costing the system more money. And these factors do not even take into account the 500 Million dollars in new income taxes.

The Personal Cost
The last paragraph brings me to my next point. How much control over our daily lives does the government intent to extract as part of this Bill? It should scare every American that the government would reach this far into our lives. The fact that they would consider tanning a luxury, and therefore subject to an additional tax is scary at best. There was a proposed tax on cosmetic surgery that was scrapped. There have also been suggestions that they tax soft drinks or sweet snacks. Are we going to visit our Doctor (once the inevitable Public Option kills competition and destroys the open market) and step on the scale...only to find out that we are five pounds overweight.

Doctor: Sorry, you are overweight. Let me suggest some options for you so you won't get hit with the fat people tax.

Patient: Well, Doc, you know I had surgery and haven't been able to work out. What is the "Fat People Tax?"

Doctor: Your current weight places you in a fifteen percent higher risk category for coronary heart disease and diabetes. This tax will be collected as part of your premium for the next twelve months until you can demonstrate you have been back underweight for sixty days. Your weight affects the cost of providing health care, so you have to contribute more to offset your potential expenses.

Where do we go from there? Genetic Testing? A tax on people pre-disposed to heart disease, cancer or other maladies? It is a slippery slope that wouldn't be as scary if not for the fact that they are already justifying this type of tax behavior right in the initial Bill. This stuff could, of course, be considered later and not raise the alarm flag. The problem seems to be that they cannot balance without new revenue.

I also have serious reservations about this Bill because it adds a large segment of the population to the health care roles without building up the provider side simultaneously. It would seem a tiered approach combined with a systematic effort to bring more family physicians on-line to handle the influx of new patients would be a better strategy. The Canadian System has been beat to death over this issue, but I have friends who have shared personal anecdotes. I grew up in a border community and know many people (as well as family) in Canada. One friend lives in a less populate area of Canada. The waiting list for a family physician in his community iseight years. That is his claim, not mine. His only option is to visit the urgent care clinic, where he stated the wait can easily run sixteen hours. What? Rationing is a real threat that no one seems to want to seriously discuss. We need to ensure that this aspect of health care reform is carefully formulated into any legislation.

Who is going to make the decisions that affect my life. Is that my decision, in consultation with my Doctor? It is currently. With the introduction of cost controls and government bureaucracy, will I be entitled to the same standard of treatment? My mother had to have stints placed two years ago for heart problems. She is already past the cutoff age for a pace-maker. She can have one if she needs it under current law. Is the government going to take that right away? It looks that way. Yet, with a straight face, they continue to say "this isn't about killing grandma." Well, yes it is. It really is. When the government decides who gets medicine, treatment or other access to health care they are interfering with a system that works. I want the government to stay out of my health care and leave it between me and my Doctor.

What are the alternatives?
First of all, any solution that does not include both parties will not work. When Ronald Reagan extended the life of Social Security, it was a brokered deal between parties. It is essential that any resolution of the legitimate health care crisis be formulated carefully with input from representatives from all of America. Ideas like allowing insurance purchases across state lines (which could lower costs by as much as five percent), expanded health insurance tax incentives, and reducing fraud, waste and abuse by employing paperless billing are all items that should be considered.

The current legislation is going to bankrupt America. I say that without flinching. The cost of health care continues to rise. Anyone who tells me that you can increase demand without increasing supply and bring down costs is naive. Bringing down costs will require comprehensive reforms rooted within the market. The government rarely demonstrates an efficient business model (postal service, Amtrak). The current bill still leaves a significant segment of the population uninsured. It proposes forced insurance on young people to balance costs (which seems un-Constitutional) and counts those forced users in the statistics. They are a segment that really doesn' t require insurance (maybe catastrophic, like I carried when I was younger). But with a large portion of the population left uninsured at a cost that cannot be calculated and is steeped in secrecy, special deals (vote buying) and hidden costs...we really can't afford this type of reform.