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● My 10 Steps to health care reform: 2 Bonuses

1. Establish a Universal Access Programs to guarantee access to affordable care for those with pre-existing conditions.
2. Prevent insurers from unjustly cancelling a policy or instituting annual or lifetime spending caps.
3. Tax code reform - provide Health care tax credits - immediate financial assistance in purchasing private health care coverage without implementing new taxes.
4. Tax credit for medical expenses not covered or over and above coverage costs.
5. Increase tax credits for business payroll and lower unemployment taxes - stimulate employment and employer investment.
6. Eliminate the barriers to buying health insurance across state lines - increase competition, decrease price
7. Repeal mandatory benefits that make health insurance needlessly expensive - pay for services you want
8. De-link health insurance from employment - create intense competition for individual customers and lower premiums.
9. Federal and State portability mandate - don’t lose coverage during transitional periods
10. Tort and frivolous law suit reform - decreases practitioner and hospital overhead.
11. Bonus 1) Total Cost: $0
12. Bonus 2) Total Jobs Lost: 0

● First think about this - Dems Rejected 11 Amendments Requiring Congress to Enroll in Gov’t-Run Health Plan Tuesday, November 10, 2009 click here. Now decide is this something you want?

● Second nugget for thought is “Massachusetts has the most expensive family health insurance premiums in the country, according to a new analysis that highlights the state’s challenge in trying to rein in medical costs after passage of a landmark 2006 law that mandated coverage for nearly everyone. The average family premium for plans offered by employers in Massachusetts was $13,788 in 2008, 40 percent higher than in 2003. Over the same period, premiums nationwide rose an average of 33 percent.” Boston Globe August 22, 2009

If you still think government run health care is the way to go then read below.

As a doctor I believe health care is a choice. You choose to have it or you choose not to have it. I believe having health insurance is better than not having it.

The mandatory health care system implemented by the U.S. House of Representatives and the U.S. Senate is an unacceptable model. The legislator is riddled with perks that increase the size of government and decrease our individual freedom of choice. Most of the statistics below were provided when the bill was at two thousand pages. Now the bill is over twenty three hundred pages.

Our House of Representative Edward Markey applauded the reforms in the health care bill - Woburn, MA - Woburn Advocate November 09, 2009 01:04 PM EST. He said

1. Comprehensive health care reform is exactly what I came here to Congress to do.
2. I am proud to say we are closer than ever to fulfilling that dream.
3. I am proud to cast my vote today for lasting health care reform that will benefit generations to come.

Below are several facts concerning the “comprehensive,” “dream,” that Rep. Markey would be “proud” of and that will “benefit generations to come.” You decide.

ABC News November 09, 2009 6:30 PM Interview with the President: Jail Time for Those without Health Care Insurance? By Sunlen Miller. Under the House bill those who can afford to buy insurance and don’t’ pay a fine. If they refuse to pay that fine there’s a threat – as with a lot of tax fines – of jail time. Mr. Obama said “penalties have to be high enough for people to not game the system.” He also said the “penalties are appropriate for people who try to “free ride” the health care system.”

The Tax Foundation compared the House and Senate health care bills. To view click here

House Bill

1. Medicare cuts - $472.8 or 39%
2. 5.4 percent surtax on high-income individuals $500,000/$1,000,000 - $460.5 billion or 38%
3. "play or pay " - employers make up the next largest percentage - $135 billion, or 11 percent
4. "pay or play" - play or go to jail
5. tax on medical devices and other healthcare revenue increases - $55 billion 5 percent
6. corporate income tax increases and other non-health revenues - $50.4 billion, or 4 percent
7. penalty on uninsured individuals - $33 billion, or 3 percent

Senate Bill

1. Medicare cuts - $377.8 billion or 41%
2. Other Health Care Cuts - $26.3 billion or 3%
3. "play or pay " - employers $23 billion, or 3 percent
4. tax on medical devices and other health care revenue - $179.1 billion, or 20 percent
5. corporate income tax increases and other non-health revenues - $100.1 billion, or 11 percent
6. penalty on uninsured individuals - $4 billion, or less than 1 percent

The San Francisco Examiner 13 New Tax Hikes in the 1,990 page house obamacare 10/29/2009 The Affordable Health Care for America Act. H.R. 3962

1. Employer Mandate Excise Tax (Page 275) - employer does not pay 72.5 percent of a single employee’s health premium (65 percent of a family employee), the employer must pay an excise tax equal to 8 percent of average wages Small employers (measured by payroll size): payroll tax rates of 0 percent(
2. Individual Mandate Surtax (Page 296) - individual fails to obtain qualifying coverage, he must pay an income surtax equal to the lesser of 2.5 percent of modified adjusted gross income (MAGI).
3. Medicine Cabinet Tax (Page 324) - Non-prescription medications would no longer be able to be purchased from health savings accounts (HSAs), Flexible Spending Accounts (FSAs), or health reimbursement arrangements (HRAs). Insulin excepted.
4. Cap on Flexible Spending Accounts (FSAs) (Page 325) - Flexible Spending Accounts (FSAs) would face an annual cap of $2500 (currently uncapped).
5. Increased Additional Tax on Non-Qualified HSA Distributions (Page 326) - Non-qualified distributions from HSAs would face an additional tax of 20 percent (current law is 10 percent).
6. Denial of Tax Deduction for Employer Health Plans Coordinating with Medicare Part D (Page 327) - erode private sector participation in delivery of Medicare services.
7. Surtax on Individuals and Small Businesses (Page 336) - income surtax of 5.4 percent on MAGI over $500,000 ($1 million married filing jointly), raise the top marginal tax rate in 2011 from 39.6 percent under current law to 45 percent.
8. Excise Tax on Medical Devices (Page 339) - new excise tax on medical device manufacturers equal to 2.5 percent of the wholesale price, excludes retail sales, unspecified medical devices sold to the general public.
9. Corporate 1099-MISC Information Reporting (Page 344) - 1099-MISC forms be issued to corporations as well as persons for trade or business payments, current law limits to just persons for small business compliance complexity reasons, expands reporting to exchanges of property.
10. Delay in Worldwide Allocation of Interest (Page 345) - Delays for nine years the worldwide allocation of interest, corporate tax relief provision from the American Jobs Creation Act.
11. Limitation on Tax Treaty Benefits for Certain Payments (Page 346) - Increases taxes on U.S. employers with overseas operations looking to avoid double taxation of earnings.
12. Codification of the “Economic Substance Doctrine” (Page 349) - Empowers the IRS to disallow perfectly legal tax deduction, other tax relief merely because the IRS deems that the motive of the taxpayer was not primarily business-related.
13. Application of “More Likely Than Not” Rule (Page 357) - Publicly-traded partnerships and corporations with annual gross receipts in excess of $100 million have raised standards on penalties, tax underpayment by these taxpayers, they must be able to prove that the estimated tax paid would have more likely than not been sufficient to cover final tax liability.

Heritage Foundation A Closer Look at the House Democrats’ Health Care Bill No. 2684 November 6, 2009 Federal Control of Health Care. To view click here.

1. Affordable Health Care for America Act (H.R. 3962) creates a new minimum federal standard benefit package
2. New bureaucracy “Health Benefits Advisory Committee,” within the Department of Health and Human Services (HHS),
3. Make detailed recommendations, which the HHS Secretary would then impose on all private insurers and employers through regulation
4. All existing employment-based health insurance coverage would have to be modified or replaced to meet the new federal benefit package by 2018.
5. 2013, all new individual or employment based coverage would have to conform to the federal minimum benefit rules
6. Limits age rating of premiums to no more than a two-to-one difference between the highest and lowest premium costs.
7. Thus, a 64-year old could not be charged more than twice the premium of an 18-year-old is about a five-to-one natural difference in the consumption of medical care between a 64-year-old and an 18-year old. The effect will be to significantly increase the cost of health insurance for young adults in their 20s and 30s.
8. HHS - given extremely vague orders to “establish a process for the annual review of increases in premiums for health insurance coverage” require health insurers to submit a justification for any premium increases prior to implementation of the increase.
9. Result in insurers being prevented from raising rates to cover increased claims costs forcing insurers into insolvency and leaving policyholders liable for provider claims.

Expanding Medicaid Dependence

1. Medicaid expansion adding as many as18 million people to the program
2. 5 million children who have been served under the successful and popular State Children’s Health Insurance Program (SCHIP) will also be transferred into Medicaid
3. More than 10 years, states have decided whether to run their SCHIP programs as a separate non-Medicaid program or as a Medicaid expansion. A separate SCHIP program provides states with greater flexibility in managing benefits, service delivery, and eligibility
4. SCHIP program, there is no individual entitlement, and eligibility is reserved only for those who were previously uninsured.
5. States had the flexibility to impose a waiting period to protect against families dropping their private coverage. All of this will be overridden under the new legislation. State SCHIP programs will be dismantled
6. Medicaid expansion was to 133 percent of the federal poverty level (FPL), not the proposed 150 percent FPL in the current bill—shows that Medicaid spending would surpass Medicare spending and grow nearly twice as fast as spending in employer sponsored insurance.
7. 2019 - one in five health care dollars will be spent through Medicaid. More than half of all health spending would flow through Medicare, Medicaid, or other public spending by 2019.1

New Taxpayer-Funded Subsidies

1. Generous taxpayer-funded subsidies to individuals and families with incomes up to 400 percent FPL (roughly $90,000 for a family of four) for coverage purchased through the new health exchange
2. Families with incomes below 350 percent FPL (roughly $80,000) could also receive cost-sharing subsidies to cover a portion of their out-of-pocket costs
3. First two years, those receiving a subsidy could only purchase the basic plan, regardless of their desire to pay for additional services
4. CBO estimates an average premium of $15,000 for a “basic” family plan with cost-sharing of about $5,500.
5. Family just under 300 percent FPL (roughly $70,000) could receive up to $10,500 in federal subsidies ($8,700 for the premium and $1,800 for cost-sharing) to cover more than half of its health care costs
6. Bill would exclude those individuals with access to employer coverage from receiving a subsidy
7. Family at 300 percent FPL (roughly $70,000) struggling to pay for their current employer-sponsored plan would generally not receive assistance at all
8. Neither would a family at 200 percent FPL (roughly $45,000) with employer-based coverage. bill would freeze existing Medicaid eligibility levels at the state level to prevent states from lowering their Medicaid programs in favor of the federal subsidy.
9. Without financial assistance, the only rational option for these low-income Americans is to join Medicaid, a substandard health care program.
10. The two tiered health care system that permanently segregates lower-income Americans, as well as those often classified as poor, from the rest of America.

New Mandates on Individuals and Employers

1. Uninsured to pay an extra income tax—2.5 percent of adjusted gross income above the filing threshold, capped at the national average premium persons who have health insurance that does not qualify as “acceptable” coverage under the new federal standards.
2. Tax would also apply to persons who have health insurance that does not qualify as “acceptable” coverage under the new federal standards Those paying this tax would remain uninsured.
3. Low- and moderate-income individuals and families would have to pay higher premiums than they would otherwise pay for health coverage to avoid the tax
4. Additional tax on those with incomes below four times the FPL (about $88,000 per year for a family of four) ranging from 1.5 percent to 12 percent
5. Tax on low- and moderate-income Americans would be in addition to a “surtax” of up to 5.4 percent on higher incomes.
6. New 8 percent payroll tax on employers who do not cover specified percentages of their employees’ health insurance.
7. Employers would have to get the money to pay the tax somewhere, and much of it would come from cutting wages or other benefits.
8. Tax would also not go to pay for any coverage; the bill specifically says that the tax paid by the employer “shall not be applied against the premium of the employee.”
9. Tax would be lower than the cost of providing health insurance (especially for low-income workers), many employers would opt to pay the tax and not offer health plans, disrupting their employees’ existing coverage.
10. Insurers and employer based plans would have five years to bring their plans into compliance

Billions in New Taxes

1. Tax increases that would cost taxpayers $700 billion over the next 10 years.
2. 5.4 percent surtax on joint filers with over $1 million in adjusted gross income or $500,000 for single filers on modified gross income, thereby increasing the overall effect of the tax.
3. Joint Tax Committee expects the cost of the surtax to more than double in 10 years, from $30.9 billion in 2011 to $68.4 billion in 2021, and that taxpayers will be forced to pay $460.5 billion in higher taxes due to this provision.
4. Limits contributions to Flexible Spending Accounts (FSAs) to $2,500 per year.
5. Limits the ability of FSAs or health savings accounts to purchase goods by excluding over-the counter drugs.
6. Taxes medical devices and self insured health plans.

The Real Cost

1. CBO’s preliminary estimate of H.R. 3962 puts the total cost of the health care coverage provisions at $1.05 trillion (with offsets bringing the net cost down to close to $900 billion).3
2. CBO has not accounted for special funding for prevention and wellness, increases in the federal Medicaid matching rate, Medicaid reimbursement for primary care physicians Former CBO Director Donald Marron - additional provisions would add $217 billion to the total cost of the House health care bill, raising the total cost to almost $1.3 trillion.4
3. Full 10-year cost puts the total close to $2.4 trillion.5
4. Real price tag for taxpayers gets higher when the cost of fixing the scheduled Medicare cuts to physicians is included. leaders propose to separate it from the larger bill in order to make their health care spending agenda appear less expensive CBO estimates the 10-year cost for this “doc fix” at over $200 billion
5. Current estimated price tag: $1.5 trillion

● Rep. Edward Markey’s website said, “The historic bill we are unveiling today will ensure that all Americans will have access to high-quality, affordable health care. Our bill preserves and strengthens the sacred trust of Medicare, provides stability and security to working families, and ensures a healthy future for our children.”

● He also said, “All Americans will have access to high-quality, affordable health care.” Both the House and the Senate health care bills are modeled after the socialized medicine programs in Britain and Canada. Read below and I’ll let you decide if this is the “high-quality” health care you want.

● Britain's Sorry Record Under Socialized Medicine To view click here.

1. Due to the chaos, 25,000 Britons die of cancer unnecessarily each year, according to the World Health Organization.
2. “National Health Service” has for years been administering “Third World cancer care” in Britain {or Health Benefits Advisory Committee in the US}
3. Britain's Sorry Record Under Socialized Medicine 500 people a year die while on the national waiting list for heart operations

● Canadian Patients Waiting Times from PCP visit to Specialist for Treatment: To view click here.

1. Cardiovascular Surgery: 7.3 weeks
2. General Surgery: 11.3 weeks
3. Gynecology: 16.1 weeks
4. Internal Medicine: 12.5 weeks
5. Neurosurgery: 31.7 weeks
6. Ophthalmology: 22.5 weeks
7. Otolaryngology: 16.9 weeks
8. Plastic Surgery: 35.5 weeks
9. Urology: 12.0 weeks

● The Canadians health care system isn't truly universal - Two Canadian Supreme Court justices made this clear three years ago when they concluded that "access to a waiting list is not access to healthcare."

● In Quebec and B.C., private clinics have been opening to treat those who either don't want to wait or are too sick to endure the system's waiting list. Whether they will remain legal and open will be decided this fall by the courts.

● Brian Day, former director of the Canadian Medical Association said, the real outrage should be that a government would actually force "a citizen in a free and democratic society to simply wait for health care, and outlaw their ability to extricate themselves from a wait list."

● Rep. Markey website said “For more than 70 years, lawmakers from both parties have worked to reform our health care system and provide high-quality care for all Americans.” Common sense says how long does it take to get it right. Representative Markey has been part of this process for over 33 years. If this is the best our legislators can do after seven decades… I believe we need new representation!

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