nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Friday, July 17, 2009


Fellow US patients,


OK, so we now have a healthcare reform bill that can be reviewed.  I haven’t read half of it yet, but I’ve been putting together some notes, so here they are.


1. It’s over 1000 pages long, but these are legal documents; they waste a lot of space on the page.  So, say, it’s about the size of the Federalist Papers that you had to read selections from in college…and less readable.  One thing you notice right away is that it refers to provisions of a number of other laws like the Public Health Service Act of 1974.  So, it will say something like, “all government approved plans will at a minimum adhere to the standards in the blah-blah-blah Act.”  So, when you add in all the requirements that are in other Acts, it’s up to about three copies worth of the Federalist Papers.


2. Another interesting piece is that it creates a number of government agencies and committees.  For instance, the Health Benefits Advisory Committee which recommends “covered benefits and essential, enhanced,

and premium plans,” to the Secretary of Health and Human Services (who has no healthcare expertise, by the way).  My guess is that this will be the process whereby the government will decide which treatments and drugs will be covered and which will not, along with the Centers for Medicare and Medicaid Services, which recently denied coverage of virtual colonography.  In Canada, the equivalent organization denied coverage of Herceptin to breast cancer patients (a breakthrough treatment for more risky cancers) until Canadian women’s outrage forced the government to reverse themselves.  Further, the same organization in Great Britain decided that the additional cost of drug-eluting stents for coronary artery blockage (to reduce re-clotting) was not justified because the ratio of the difference in cost from standard stents to the difference in outcomes of regular versus drug-eluting stents was not above a calculated threshold for effectiveness.


For the mathematically challenged, like me, this boils down to the fact that, if it costs more than about $40K to get you another good year of life, then the government says you can’t have it.


Unless you’re wealthy enough to go the US.


There’s a great article here on this issue, that finally gets down to the nitty-gritty of universal care:  The author is a famous philosophy professor who has proposed elsewhere that animals should have the same civil rights as humans, and that children only become people for the purpose of having any civil rights when they reach seven years of age.  Wacky (I’m tempted to say he’s joking, but I don’t think so), but this article cuts through all the BS of the politicians:  what dollar amount do we as a society put on the value of human life? 


You can see the difficulty with a government determination of what healthcare is best for you.   Some legal scholars have suggested that government-directed healthcare is unconstitutional under the “right to privacy” elaborated by the Supreme Court (a la Roe v Wade).  Now THAT’S going to be interesting.


3.  Under the section ironically titled “Protecting the Choice to Keep Current Coverage” (pg 16),  it says in effect, “sure, you can keep your current plan if you like, as long as your insurer makes no changes, up or down, in deductibles, co-pays, or benefits…or you’ll have to move to a government-approved plan.”  Nor can existing employer plans enroll new customers after the bill is passed, and in 5 years the insurer has to change that plan to the government-approved set of benefits (pg 17).


I don’t think I have the same definition of “choice” that the government has.


4.  If you’re not covered now, and can’t show to the IRS that you have enrolled, you will be charged a penalty and forcibly enrolled in a government-approved plan NOT of your choice (pg 167).  The penalty will be about what you would have paid had you enrolled in a govt plan.


Again…choice.  I don’t think the 18-25 year olds realize that despite the fact that they have few risks, and don’t want insurance, they will have no choice.  We can’t let the folks who don’t need healthcare escape their responsibility.  The same thing is happening with Social Security and Medicare:  we old folks are living off their contributions.


5.  The bill says that families making up to about $88,000 a year will be eligible for subsidies (the key is the Federal Poverty Level, and the bill says that up to 400% of FPL get a break).  That is, their costs will be paid by others. 


The IRS estimates that about 47% of adult Americans will owe no tax this year (up from ~40% in recent years).  This is approaching a majority of the nation.  The danger is that when a majority of the citizens are receiving assistance and have no investment in the costs, they will elect and promote representatives that will continue to vote for more free stuff.


6.  I’m wary of the consultation required at least every five years of all people over the age of 65 (page 425).  There’s a good side to this:  I think everybody should think about end-of-life decisions, in consultation with their doctor.  But I’m concerned when the government requires that I be reminded of my final “check-out” every five years, and then spends five pages in the law telling me what I have to consider.


I’m certain this in an area where those critics who argue against “a bureaucrat coming in between you and your doctor” are correct.


7.  Lastly, the financing for all this has been described by some as “not incurring additional costs” after the whopping $1.3 trillion initially projected.  I don’t see any of that.  What I DO see is transferring the costs to other semi-hidden fees, taxes, penalties, surcharges, and licenses.  There are other cost-transfers like reducing payments for Medicare (not through reducing fraud, just by cutting the reimbursement…already so low that many doctors won’t take new Medicare patients.) 


So, the costs are still there. 


I thought we were doing this to “insure the uninsured” and “reduce the unsustainable costs of care.”   What happened to the second part?




Overall, this bill does not, in the words of the Congressional Budget Office Director, propose "the sort of fundamental changes" necessary to rein in the skyrocketing cost of government health programs.  If you remember my previous discussions of what Massachusetts has done to implement universal healthcare, here’s an update:  the state is broke from healthcare costs rising 33% faster than the rest of the nation, there are still a percentage who are not covered, some people are enrolling only when they have an expensive healthcare need and then cancelling once paid, and finally, the state is considering throwing out the whole reimbursement system.  Not good…


The bill (HR 3200) is not fun reading for most people, but I recommend you take a look at the text if you have the time.  Don’t read the “executive summary”, that’s just a glowing advertisement for the bill, and is meant to persuade you that this is all goodness.


If you do invest the time to read some portion of the bill, congratulate yourself.  At least you’ve read more than the members of Congress will.


Oh, and with all the criticism our healthcare system has undergone, don’t forget that the World Health Organization ranks it #1 in the world for responsiveness to patients’ needs and timely treatments.


Doc D



Opinions are entirely my own.  As always, you may share this column, with appropriate attribution (here and in the text) included.




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