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Day 2 of 206- reading the Senate Health Care Bill

January 26, 2010 by davidfisher · Leave a Comment 

Pages 30-40
Section 2717 “Ensuring the Quality of Care”
This phrase alone makes me shudder.  What makes government think it can “ensure” quality of care?  So far it has been unable to do so with the plan it does run, Medicare.
Says that the government will establish “reporting requirements” whereby health plans will have to show that they have improved health outcomes and are compliant with government-established “best practices.”  Other activities they will be required to report on are “wellness and health promotion activities” (i.e. smoking cessation, stress management, physical fitness, nutrition, etc.) and “activities to prevent hospital readmissions.”  These reports must be submitted annually.
In my experience with government, this will do nothing to ensure quality of care.  It will ensure that doctors, insurance companies, and hospitals spend a lot of extra time and effort figuring out how to generate these reports and how to ‘look good’ to the government.  Time spent jumping through more hoops is time taken away from you, the patient.
Section 2718 “Bringing Down the Cost of Health Care”
a) Health plans have to submit a breakdown of their expenses into 3 categories:
  • direct clinical services
  • activities that improve overall health care quality
  • administrative costs (excluding State taxes)

These reports will be posted on the internet by the Dept of Health and Human Services

b) Each year, health plans must give a rebate to their enrollees if they spend more than 20% of their premiums on administrative costs, as described in the report.

This will simply lead insurance companies to hide administrative costs in their “clinical” services.  Under this rule, there is no way a smart health insurance company would ever let their report reflect that they spent more than 20% of premiums on administrative costs, whether it benefited their customers or not.  Therefore, they will rename certain administrative costs in order to get them to fall under the first 2 categories in the above report, clinical services or health care quality improvement.  You may end up dealing with more administration and bureaucracy in your health plan, so that the insurance company can claim these administrative activities were a clinical service.
Bottom line: insurance companies will be financially motivated to place more bureaucratic hoops between you and your doctor
The bill claims to protect against this maneuvering by promising to establish “uniform definitions” of the activities that are to be reported.
Section 2719  Appeals Process
Establishes a process for appealing a claim- most plans have this already
Section 2793  Health Insurance Consumer Information
Lets the federal government give grants  to States ($30 million per year) to set up departments of “health insurance consumer assistance” to help people find insurance, file claims, and track problems.
These departments will then report on the “types of problems and inquiries encountered by consumers” and the Secretary of HHS will use this information to determine “where more enforcement action is necessary.”
The bill only mentioned reporting on problems.  HHS is apparently only interested in where people are complaining.  There is no mention of reporting States that are doing things well.  Essentially, this is the establishment of a nationwide “complaints” department with outposts in every state sending reports back to HHS so they can bring more “enforcement action” against the states that are getting the most complaints.
A tremendous amount of government control in this bill so far.
Let’s call today the Left parietal bone.



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