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OPINION – Democrats’ healthcare and small business Part 2 of the continuing horror I’m reading the thousand-plus-page House healthcare act from the perspective of a small-business person running a business of under 20 employees. So I’m coming to the project with this out-in-the-open bias: How is this proposed change in healthcare going to affect one small company, its employees, me and my family? I said last week that the bill yet to be voted on by the full House is even worse than its opponents have painted it to be. In the first few pages, I’ve read that the bill’s purpose is to “set standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections.” What’s “affordable”? A Ferrari is “affordable” to some folks. It’s not “affordable” to me. Should Congress pass a law mandating that the only automobiles allowed to be sold must cost under ... what? $40,000? $30,000? $20,000? See the problem? If you say, “Well, it’s not the government’s business to set prices for cars,” I’d reply, “Exactly. So why are the Democrats trying to do that very thing for medical care?” I’ve seen the argument that requiring every American to submit to either paying for a health policy or paying a tax penalty in lieu of that coverage is analogous to the state requiring every driver to possess a minimum amount of automobile liability insurance. That’s a false argument. If I choose not to own or operate a car — relying on the much ballyhooed “public transit” option — no law is going to force me to pay for car insurance. Driving is considered a “privilege,” allowing the state to require insurance. Healthcare coverage is no more a “privilege” than life insurance coverage is, however wise it might be to carry life coverage. And why has healthcare suddenly become a “right,” occupying a higher notch even than the also recently discovered “right” to housing? Where is such a “right” enshrined in our nation’s constitution? A right is something that you innately possess, to exercise or not to exercise as you choose. A right is not something for which you can present a bill to a government and demand payment for your “right” from other citizens, even if those other citizens object to paying for your “right.” But I digress. In pages 15-16 of HR 3200, we’ve discovered that the current health plan that my business partially pays for must — within five years — meet the Democrat Commissar’s standards (see last week’s installment for explanations of the Commissar and her vast powers). We’ve found that my current plan is grandfathered in for those five years, with an important exception: After HR3200 becomes law, my health plan cannot enroll any additional employee that I may hire. So what happens to the new employees? More on that later. On pages 17-18 is what nobody is telling you: Yes, you can choose whatever plan you can pay for — for five years. What nobody is saying is this: After year five, “an employment-based health plan in operation as of the day before the first day of [year] one must meet the same requirements as apply to a qualified health benefits plan” as decided by the Commissar. In other words, all — ALL! — plans must offer essentially the same coverages, with the same benefits and with the same “consumer protections.” Cookie-cutter plans — and that’s what Obama calls “choice”? Like Henry Ford famously said about color choices among his early automobiles: “They can have any color they want, so long as it is black.” Starting on page 19, the bill mandates that insurance companies cannot refuse coverage because of your pre-existing conditions. Then it sets up “insurance rating rules.” You read correctly: The free market, private system of every company determining its own levels of acceptable risk in exchange for issuing insurance will be against the law. Instead, the government will now take over that function. One size fits all. Obama knows best — better than any actuary, better than any insurance company, better than you. The Commissar will enforce this specialized form of government price-fixing. On pages 21-22, the Commissar and her helpers will “conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following: “(A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure. “(B) The similarities and differences between typical insured and self-insured health plans. “(C) The financial solvency and capital reserve levels of employers that self-insure by employer size. “(D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent. “(E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self-insure.” I quoted that in its entirety because it is so breathtaking in its invasive scope. The Democrats’ Commissar will launch audits of any company she so chooses. Why? Page 22-23: “Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers.” Starting on page 24, the Commissar will inspect “provider networks” (that’s doctors and hospitals, all of them) to bring these tens of thousands of private businesses into line with the Commissar’s rules. That is simply breathtaking. To use a favorite teen word: This is an “awesome” expansion of government power over private enterprise. Beginning on page 25, the Democrats and their appointed Commissar will determine what “essential benefits” will be covered. No arguments or free market choices, now, you unruly mob of Rush Limbaugh-controlled miscreants. Obama — and his army of bureaucrats — know what benefits you should have and you will get them whether you like them or not. No messy shopping list of optional benefits and multiple levels of coverages now available under our free market system. Be glad to escape such confusing choices — the Democrats will choose for you. We examined the Health Benefits Advisory Committee (and its admirable inclusion of at least one practicing doctor among its expert panelists) in last week’s installment. And we covered the “additional consumer protections” last week as well, including the penalty section that allows any employee of just about any size small business to file a federal complaint against the employer under the Consumer Product Safety Act (!). I wonder how much my yearly liability insurance premium will get jacked up by this new set of federal healthcare violations risks. No Obama bailout money is available for me to pay that new, increased business expense. The bill spells out beginning on page 57 the Commissar’s requirements for “financial and administrative transactions.” That innocuous language will mean that innumerable doctors’ offices and hospitals and clinics will have to line up their billing practices with the new federal regulations. Goodbye, paper; hello, standardized computers — in every medical office, in every state — within five years. I suspect the Democrats don’t expect tax money to pay for those mandated small-business expenses. OK, here’s the first really scary personal intrusion part: Page 58. The medical care billing rules require the following (and this is verbatim from the bill): “(D) Enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card; ...” Folks, read that paragraph again and tell me you don’t see a government computer terminal bureaucrat scrutinizing your name, your financial and medical history and your national ID card — while you are standing in line, awaiting her determination — before she allows you to get medical care at that particular doctor’s office. If that does not qualify as scary, I don’t know what would scare you. Pressing on to page 65, we find the U.S. government setting up a $10 billion “reinsurance” fund “to assist participating employment-based plans” in paying for health benefits for retirees, spouses and dependents. Now who are these “retirees” that get such additional government money? Some of you may have guessed that “union” is the hidden word in this Democrat payoff. Yep, union retirees are more special than other retirees, worthy of receiving specialized added tax “investments.” The bill on page 80 defines who gets hit in three categories: “Smallest employer” has 10 or fewer employees; “smaller employers” are those small businesses with between 11 and 20 employees; and “larger employers,” which is every other business in America with more than 20 workers. Here comes another Commissar audit. She will require every business to give exhaustive details of what health benefits the business is offering to its workers, how much it costs and its “affordability” (I guess the Commissar will determine the dollar amount that is presumed to meet the “affordability” standard). In addition the Commissar will (and this is verbatim) “examine ... the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.” Now, that seems to mean that the nosy Commissar will require workers who decline coverage to explain what their finances are and why they are not participating in ObamaCare. Section 203 on page 84 gets into the nitty-gritty of what plans may be offered. It’s not complicated: “Required offering of basic plan — The [insurance company] offers only one basic plan for such service area.” If the insurer offers a basic plan, then it may offer one — and only one — “enhanced” plan for that service area. If the insurer offers its one “enhanced” plan, it may also offer one — and only one — “premium” plan for that area. If the insurer offers its one — and only one — “premium” plan, then it may also offer one or more (!) “premium-plus” plans for that area. What is a “premium-plus” plan? One that offers “adult oral health and vision care, approved by the Commissioner” (Commissar). What differentiates the other lower grade plans: something the Democrats call “tiered cost-sharing.” More on that later. Here’s an interesting little kicker to this section: “The [insurer] shall provide for culturally and linguistically appropriate communication and health services.” Can’t you just see it now — your insurer sends you your benefits package in all the languages determined to be present in your census tract, from Spanish to Swahili, from Arabic to Zulu. And you’ll meet a swarm of translators required by law to be present at the front desk of every doctor’s office in America. And Obama is going to save billions and trillions with this plan? But, hey, job creation is job creation, right? And in Section 205 beginning on page 95: The Commissar “shall establish and carry out an enrollment process for Exchange-eligible individuals and employers, including at community locations ... Such process shall provide for enrollment through means such as the mail, by telephone, electronically, and in person.” Obama the community organizer, organizes America. Line up in front of Publix and Kroger to get your mandatory federal health ID card issued, on the spot, with your finances checked to see which plan you get. Don’t want to participate? How about automatic enrollment? The Commissar “shall provide for a process under which individuals who are Exchange-eligible ... are automatically enrolled under an appropriate Exchange-participating health benefits plan. Such process may involve a random assignment or some other form of assignment that takes into account the health care providers used by the individual involved or such other relevant factors at the Commissioner may specify.” I can’t make such stuff up. It’s right there in HR 3200, pages 97 and 98, in plain text. Now comes the part you’ll really love, because it involves taking extra money right out of your paycheck or your company payroll. On page 109, the Democrats create in the “treasury of the United States a trust fund ... to make payments to operate the Health Insurance Exchange ...” You might ask, where does that money for this new “trust fund” come from? I can’t make this up; it’s right there in HR 3200: “(A) Taxes on individuals not obtaining acceptable coverage ... “(B) Employment taxes on employers not providing acceptable coverage ... relating to employers electing not to provide health benefits. “(C) Excise tax on failures to meet certain health coverage requirements ... with respect to failure to meet health coverage participation requirements.” That provides me with an authentic and heart-felt “Oh, my God” moment. Obama and the Democrats are hell-bent on taxing us into oblivion. Margaret Thatcher, then prime minister of Great Britain, said, “The problem with socialism is that eventually you run out of other people’s money.” We have reached only page 111 of 1,017 pages. Can it get any worse? Yes, as you’ll see in my next installment. — Posted Aug. 13, 2009, 11:53 p.m. ++++++++++++++++++++++++++ Addendum, Saturday, Aug.8, 2009: A discussion of "rights" Let’s have a reasoned conversation based just on the facts and the logic of the healthcare reform issue and its philosophical (or ideological) underpinnings. Buck, you state that the “essence of the debate starts with the notion that ‘affordable and quality healthcare for every American citizen in our country is a right ... not a privilege.’” I disagree with the starting point (I think the more fundamental debate is the proper role of government in our constitutional republic), but let’s take your argument on its merits. Who says that healthcare is a right? Is that open to debate with you, or is that kind of a religious position, unassailable by logic or facts or an examination of our country’s history? But again, taking your position on the merits, let’s define our terms, starting with “right.” Is it a right of the same type as the 1st amendment right to free speech, or the 2nd amendment right to bear firearms or the 3rd amendment right ... ? Well, you get my point. If your right to healthcare is a constitutional right, would you please point out where it is expressed in the U.S. Constitution? Or even a federal court ruling? If healthcare is — on the other hand — an “unenumerated” right that has to be discovered in the Constitution’s “penumbra” by the U.S. Supreme Court, could you specify where that ruling might be found? I think the answer to the above questions is that nowhere is such a right recognized by our founding document or by our highest court. So then, if it’s not in the Constitution or our laws (yet), when did such a “right” show up on the American scene? More to the point, when did you — Buck — discover YOUR right and MY right to — not just any old healthcare, but “affordable” and “quality” healthcare? Is this a relatively recent right? It must be, because I’ve got gray hair and I don’t remember anybody — and I mean anybody — asserting such a right until very recently. (Gosh, we need a scorecard to keep up with all of these recently discovered “rights.”) Or is this a “right” that only people of a certain income or ethnicity or general put-upon-ness or down-and-out-ness may rightly possess and not us self-absorbed types? Did somebody one day discover this healthcare right? I think I may safety assert that George Washington would have been unaware of such a right, as would Thomas Jefferson and James Madison and all those old guys we don’t pay much attention to anymore. I even have a sneaking suspicion that John F. Kennedy would have been unaware of such a “right,” and he was a pretty progressive fellow. Buck, do you disagree with the argument so far? If so, specifically what do you disagree with and state your logic behind your position. You said, “You either believe that and embrace the notion, or you don’t.” I totally agree with your assessment in that statement. You assert and I disagree that healthcare is a right. I point out what should be self-evident to you: You and I can have all the “notions” we choose to indulge, but our respective “notions” don’t rise to the level of “rights” just because we claim them to be rights. Or just because we harbor the “notion” that we are morally superior to other, less enlightened, self-absorbed folks. But to take your argument even a farther step, if there is indeed such a “right” as you assert, how may that “right” be enjoyed by all who possess that new unalienable right? Like my “cars and healthcare” analogy, Buck, I’ll alert you to this: the following is an analogy. Suppose that I assert that my 1st amendment right to print what I believe doesn’t end at MY pocketbook. Suppose I assert that, in furtherance of my 1st amendment right, I must confiscate — let’s say — $20 a week from your bank account so that I may enjoy my 1st amendment right to its fullest extent. I set $20 because I want to remain “affordable” but I also want my asserted product to be what I consider “quality.” (By the way, old self-absorbed “I” made that determination about what’s “affordable” and what’s “quality.” You didn’t get to have a say in that determination, did you? How do you feel about that?) Now further suppose I have sufficient enforcement power to take your $20 a week whether you wish to give it to me or not and that you have no recourse but to submit and let me have it. After all, it’s only $20 a week. You spend that much a week on morally superior coffee. But your coffee right is inferior to my 1st amendment right and need. You know — the greater good. So, Buck, what’s wrong with this picture? Do you really think my “right” extends so far as to require money out of your pocket, without your consent? Now remember, the rules of this game — which power-hungry and self-absorbed “I” set without any input from you — don’t allow you to resist my taking of your money for my “rightful” purposes. If the scenario I described above were to really happen, do you suppose you might become a strong advocate of the 2nd amendment and take strong measures to keep me from taking your $20 a week, from here on out, for the rest of your life? I assert, Buck, that you and your liberal friends on this thread cannot make a coherent, logical, fact-based argument to prove that healthcare is an unalienable right (you remember “unalienable,” don’t you?). And beyond that, you cannot assert a moral basis for your right to reach into my pocket to steal my money in order for you to pay for treating your ingrown toenail. You assert a “greater good.” Who gets to determine that “greater good”? Liberals who want to take my money to make themselves feel better about themselves as morally superior to all us self-absorbed moral midgets? I assert a greater good is freedom of the individual from the coercive and often foolishly ignorant and destructive power of the state — Mr. Obama and the Democrats being the visible agents of such misguided power. I assert that freedom from the state’s arbitrary and unbridled power is a right — one of those unalienable ones — that is greater than your johnny-come-lately “right” of affordable healthcare at my expense. If you and your friends have a higher “right” than freedom, then appeal to it and declare its basis. Otherwise, another one of those old, old rights is your right to feel morally superior to others who disagree with you. It is one of those lesser “rights” nestled in the much bigger one called “freedom.” From my “self-absorbed” perspective, I think such moral superiority more likely is smug self-righteousness. But, hey, you’re free to disagree. [The above is a copy of a comment by the author in this thread.] +++++++++++++++++++++++++ If healthcare is neither a right nor a privilege, then what is it? It is a commodity Healthcare is an artificial construct, a quick policy shorthand for a vast and intricate interrelated set of of products, services, buying and selling decisions and capital. Individual pieces of that construct are in fact just like bread and milk and truck driving and wholesalers and farmers and buyers and sellers, etc. — individual commodities and individual services offered for sale in a capitalistic free-market economy. Do you have a "right" to bread? Do you have a privilege to eat bread you neither bought nor baked yourself? Make an unemotional, fact- and logic-based case for your general and unfettered right or privilege to walk into a grocery store and steal a jug of milk without paying for it. If you don't have a "right" to something as basic as bread (find that in the Constitution) why do you have a right to free or taxpayer-subsidized services and products from these millions of individual sellers of their services and products? How should healthcare be distributed? The same way bread and milk are distributed: The individual with the product or service reaches an uncoerced agreement to sell the product or service to the willing buyer at a mutually agreed-upon price. That's called free-market capitalism. That's what got us this amazing "healthcare" system in the first place. Charity for truly needy cases should likewise be an individual, noncoerced decision. You have no God-given or otherwise-given "right" to reach into my pocket to take what I worked for and convert it to your own uses without my permission. If I deny permission, get your hand out of my pocket. My argument is based on the concepts of individual freedom and individual property rights. What is yours based on? login to post comments | Cal Beverly's blog
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