Yonivore
09-10-2009, 03:49 PM
...looked at HR3200 like this.
William A. Jacobson, Associate Clinical Professor of Law, Cornell Law School and, blogger at Legal Insurrection, engaged in an interesting exercise…
Here, I’ll let him explain:
No one has been able to get a full grasp on the scope of the health care system restructuring proposed by the Democrats. I have written extensively on some ( http://legalinsurrection.blogspot.com/2009/08/irs-new-health-care-enforcer.html) of the more ( http://legalinsurrection.blogspot.com/2009/08/taxing-your-mere-existence.html) interesting tax ( http://legalinsurrection.blogspot.com/2009/08/health-care-tax-insanity-chronicles.html) provisions, but I only have scratched the surface. The pending House ( http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf) and Senate ( http://help.senate.gov/BAI09A84_xml.pdf) HELP Committee bills are the size of a major city phone book.
So I decided to use an approach I have seen on television ( http://www.cbsnews.com/stories/2002/05/16/earlyshow/bios/main509349.shtml), where a reporter randomly throws a dart at a map of the United States, then pulls the phone book for whatever location was selected, picks a page and person randomly out of the phone book, then visits the person to get his or her life story. Often the result is interesting, although sometimes quite boring.
For the Democratic proposals, I'm going to work off of HR3200, which also is known as the ‘‘America’s Affordable Health Choices Act of 2009,’’ but for current purposes, the "House Bill." I've chosen the House Bill, rather than the Senate version, because the House Bill is just over 1018 pages, which works better with my random selection method. The Senate bill is 615 pages, and contains some real doozies ( http://legalinsurrection.blogspot.com/2009/08/leave-our-vending-machines-alone.html), so I hate to pass up the opportunity, but the House Bill will work better.
I will look at my Sitemeter ( http://www.sitemeter.com/?a=stats&s=s32legalinsurrection&r=11) page count for seven straight days, and whatever the last three digits are on the page count, I will turn to that page in the House Bill. I will use whichever section of the House Bill appears at the top of the page, even if the section starts on prior pages.
I will try to explain what the section and provisions on the page mean. There is no guarantee that I will be able to do so, as some of these provisions may be incomprehensible. The fact that a particular page or section is incomprehensible is interesting in itself, considering there are over 1000 pages. I invite readers to post comments with alternative explanations, and corrections to my analysis are invited. Here goes.
Then, over the proceeding seven days, Professor Jacobson “threw darts” and tried to make sense of the provisions on the randomly, Sitemeter-selected, pages of HR3200.
Throwing Darts At HR3200 - Day 1 (http://legalinsurrection.blogspot.com/2009/08/throwing-darts-at-hr3200-day-1.html)
VERDICT: Close to incomprehensible. I think this means that there will be an increase in reimbursements to states for payments to primary care physicians under Medicaid. I could be wrong. There are so many cross-references, that it would take hours to figure out the full implications and all the conditions to which such payments are made, much less the source of revenue for the payments.
What this section does show is the density of the House Bill. Understanding just this single provision is a daunting task. Call it the banality of bureaucracy. Someone, be it a lobbyist or staffer or both, spent an enormous amount of time writing this dense text to accomplish something which is not explained in a form almost anyone could understand or comprehend.
Throwing Darts at HR3200 - Day 2 (Enhanced Penalties) (http://legalinsurrection.blogspot.com/2009/08/throwing-darts-at-hr3200-day-2-enhanced.html)
VERDICT: The lesson would be that if you do business with the government health care system, your business is an open book subject to inspection and access at any time.
Throwing Darts at HR3200 - Day 3 (Cost Sharing Limits Gone Wild) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-3-cost.html)
VERDICT: Now I understand that the devil is not just in the details, it is the details. This random selection method has forced me to try to understand provisions which are so imposing that the eye naturally averts to something easier to understand.
Given a choice, I never would read these sections. And this is just day three.
Throwing Darts at HR3200 - Day 4 (Birth of a New Entitlement) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-4-birth-of.html)
VERDICT: I propose changing the title of Section 1302 from the “Medical Home Pilot Program” to the “New and Permanent Medical Home Program Entitlement.”
Update: Some of the commenters at American Thinker note that the concept of a "medical home" is not new, it essentially is managed care. But what does seem new is the payment by the federal government for such services including services in a "home setting," which is the language used in this Section. I invite comments on this point, either here or at AT.
Throwing Darts at HR3200 - Day 5 (Cutting Hospital Readmissions) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-cutting.html)
Professor Jacobson didn’t provide a “verdict” summary so, I’ll quote his last paragraph which appears to be a summary of sorts.
By pitting individual needs against societal needs, Section 1151 is a microcosm of the health care cost debate. Once again, we seem to come back to a definitional problem. Whether Section 1151 is good or bad depends on what the definition of “excess” is.
Throwing Darts at HR3200 - Day 6 (No Mulligans) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-6-no.html)
Again, no “verdict” paragraph…
Under the plans for QHBP’s, it is not clear that a patient will be able to pay for services otherwise denied, and then seek reimbursement through the courts. When government decrees that a certain service or product is not to be provided, it is not provided regardless of the patient’s ability to pay.
Under the House Bill, there are no health care mulligans.
Throwing Darts at HR3200 - Day 7 (Don't Wish Too Hard) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-7-dont.html)
The House Bill increases the rebate on prescription drugs dramatically. Will there be unintended consequences? While beating up the pharmaceutical companies will be popular, from where will the next miracle drugs arise? The same drugs which, while expensive, prolong lives, ease suffering, and often eliminate the need for expensive surgery.
When it comes to beating up the pharmaceutical industry, don’t wish too hard for something, you may get it.
Interesting reading if you’re able.
In addition, Professor Jacobson has written other analysis of HR3200 that should be troubling to anyone…
IRS as the health care enforcer (http://legalinsurrection.blogspot.com/2009/08/irs-new-health-care-enforcer.html)
Bureaucracy Expansion Act of 2009 (http://legalinsurrection.blogspot.com/2009/08/bureaucracy-expansion-act-of-2009.html)
Professor Jacobson has expended considerable time on trying to make sense of HR3200. I would invite anyone in here to provide a similarly thoughtful examination of the legislation, from a pundit on the left.
William A. Jacobson, Associate Clinical Professor of Law, Cornell Law School and, blogger at Legal Insurrection, engaged in an interesting exercise…
Here, I’ll let him explain:
No one has been able to get a full grasp on the scope of the health care system restructuring proposed by the Democrats. I have written extensively on some ( http://legalinsurrection.blogspot.com/2009/08/irs-new-health-care-enforcer.html) of the more ( http://legalinsurrection.blogspot.com/2009/08/taxing-your-mere-existence.html) interesting tax ( http://legalinsurrection.blogspot.com/2009/08/health-care-tax-insanity-chronicles.html) provisions, but I only have scratched the surface. The pending House ( http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf) and Senate ( http://help.senate.gov/BAI09A84_xml.pdf) HELP Committee bills are the size of a major city phone book.
So I decided to use an approach I have seen on television ( http://www.cbsnews.com/stories/2002/05/16/earlyshow/bios/main509349.shtml), where a reporter randomly throws a dart at a map of the United States, then pulls the phone book for whatever location was selected, picks a page and person randomly out of the phone book, then visits the person to get his or her life story. Often the result is interesting, although sometimes quite boring.
For the Democratic proposals, I'm going to work off of HR3200, which also is known as the ‘‘America’s Affordable Health Choices Act of 2009,’’ but for current purposes, the "House Bill." I've chosen the House Bill, rather than the Senate version, because the House Bill is just over 1018 pages, which works better with my random selection method. The Senate bill is 615 pages, and contains some real doozies ( http://legalinsurrection.blogspot.com/2009/08/leave-our-vending-machines-alone.html), so I hate to pass up the opportunity, but the House Bill will work better.
I will look at my Sitemeter ( http://www.sitemeter.com/?a=stats&s=s32legalinsurrection&r=11) page count for seven straight days, and whatever the last three digits are on the page count, I will turn to that page in the House Bill. I will use whichever section of the House Bill appears at the top of the page, even if the section starts on prior pages.
I will try to explain what the section and provisions on the page mean. There is no guarantee that I will be able to do so, as some of these provisions may be incomprehensible. The fact that a particular page or section is incomprehensible is interesting in itself, considering there are over 1000 pages. I invite readers to post comments with alternative explanations, and corrections to my analysis are invited. Here goes.
Then, over the proceeding seven days, Professor Jacobson “threw darts” and tried to make sense of the provisions on the randomly, Sitemeter-selected, pages of HR3200.
Throwing Darts At HR3200 - Day 1 (http://legalinsurrection.blogspot.com/2009/08/throwing-darts-at-hr3200-day-1.html)
VERDICT: Close to incomprehensible. I think this means that there will be an increase in reimbursements to states for payments to primary care physicians under Medicaid. I could be wrong. There are so many cross-references, that it would take hours to figure out the full implications and all the conditions to which such payments are made, much less the source of revenue for the payments.
What this section does show is the density of the House Bill. Understanding just this single provision is a daunting task. Call it the banality of bureaucracy. Someone, be it a lobbyist or staffer or both, spent an enormous amount of time writing this dense text to accomplish something which is not explained in a form almost anyone could understand or comprehend.
Throwing Darts at HR3200 - Day 2 (Enhanced Penalties) (http://legalinsurrection.blogspot.com/2009/08/throwing-darts-at-hr3200-day-2-enhanced.html)
VERDICT: The lesson would be that if you do business with the government health care system, your business is an open book subject to inspection and access at any time.
Throwing Darts at HR3200 - Day 3 (Cost Sharing Limits Gone Wild) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-3-cost.html)
VERDICT: Now I understand that the devil is not just in the details, it is the details. This random selection method has forced me to try to understand provisions which are so imposing that the eye naturally averts to something easier to understand.
Given a choice, I never would read these sections. And this is just day three.
Throwing Darts at HR3200 - Day 4 (Birth of a New Entitlement) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-4-birth-of.html)
VERDICT: I propose changing the title of Section 1302 from the “Medical Home Pilot Program” to the “New and Permanent Medical Home Program Entitlement.”
Update: Some of the commenters at American Thinker note that the concept of a "medical home" is not new, it essentially is managed care. But what does seem new is the payment by the federal government for such services including services in a "home setting," which is the language used in this Section. I invite comments on this point, either here or at AT.
Throwing Darts at HR3200 - Day 5 (Cutting Hospital Readmissions) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-cutting.html)
Professor Jacobson didn’t provide a “verdict” summary so, I’ll quote his last paragraph which appears to be a summary of sorts.
By pitting individual needs against societal needs, Section 1151 is a microcosm of the health care cost debate. Once again, we seem to come back to a definitional problem. Whether Section 1151 is good or bad depends on what the definition of “excess” is.
Throwing Darts at HR3200 - Day 6 (No Mulligans) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-6-no.html)
Again, no “verdict” paragraph…
Under the plans for QHBP’s, it is not clear that a patient will be able to pay for services otherwise denied, and then seek reimbursement through the courts. When government decrees that a certain service or product is not to be provided, it is not provided regardless of the patient’s ability to pay.
Under the House Bill, there are no health care mulligans.
Throwing Darts at HR3200 - Day 7 (Don't Wish Too Hard) (http://legalinsurrection.blogspot.com/2009/09/throwing-darts-at-hr3200-day-7-dont.html)
The House Bill increases the rebate on prescription drugs dramatically. Will there be unintended consequences? While beating up the pharmaceutical companies will be popular, from where will the next miracle drugs arise? The same drugs which, while expensive, prolong lives, ease suffering, and often eliminate the need for expensive surgery.
When it comes to beating up the pharmaceutical industry, don’t wish too hard for something, you may get it.
Interesting reading if you’re able.
In addition, Professor Jacobson has written other analysis of HR3200 that should be troubling to anyone…
IRS as the health care enforcer (http://legalinsurrection.blogspot.com/2009/08/irs-new-health-care-enforcer.html)
Bureaucracy Expansion Act of 2009 (http://legalinsurrection.blogspot.com/2009/08/bureaucracy-expansion-act-of-2009.html)
Professor Jacobson has expended considerable time on trying to make sense of HR3200. I would invite anyone in here to provide a similarly thoughtful examination of the legislation, from a pundit on the left.