Tuesday, October 20, 2009

1502 Pages

1502 Pages

The Senate's health care reform bill is here. It is 1502 pages long. The table of contents listing its sections is 13 pages alone. So why is it so long? Because it is trying to do too many things at once. There are sections for "Encouraging Development of New Patient Care Models" and "Linking Payment to Quality Outcomes Under the Medicare Program" and "Improving Payment Accuracy."

Many of these individual sections probably do good things--but why did they have to be bundled with so many other unrelated sections? Were they not strong enough to stand on their own? Could we not have passed a "Linking Payment to Quality Outcomes Under the Medicare Program" bill by itself? Why not? Is there something in there that required a quid pro quo to get it passed?

If these changes are necessary to save enough money to pay for the rest of the program, and they are so clearly going to save money--why didn't Congress vote those measures into law months ago, and start saving money immediately? My guess is that either the cost savings isn't that clear, or there is some special interest group that Congress has to pay off to get some other part of this Frankenstein's monster passed.

I am one of those people that suspects that bogus malpractice lawsuits, while a real problem, are not the major part of our health care costs. Yes, there are some spectacular lawsuits based on bogus science. Yes, those lawsuits encourage defensive medicine--ordering more tests than are really necessary--but my experience from the time when I was briefly uninsured, many years ago, is that the presence of insurance tends to drive extra tests, too. It doesn't cost anything (at least for the doctor or the patient), so you might as well be sure. Still, some restraints are probably necessary--so what does this bill say about the subject of medical malpractice? Pages 1211-12 essentially say, "Yeah, Congress should consider maybe looking into this." There's nothing except empty platitudes and "Congress should consider" on those pages.

There are provisions related to encouraging reduced teen pregnancies starting on page 503. This is a non-controversial idea to just about everyone, and yes, the bill does seem to have provision for "messages that focus on abstinence, responsible behavior and choices, family communication, relationships, and values." (While I can't follow exactly what the strikeouts are doing to the current code sections, section 1804 of this bill seems to restore abstinence education funding.) I would prefer that we reduce teen pregnancies by persuading teens to delay sexual activity, but contraception is still a vast improvement over abortion. But again: why couldn't this be a separate bill? It would allow a straight up and down vote that could have been passed through Congress and signed into law months ago--and this bill would be that much simpler.

Starting on page 508 is a section concerning "Programs of Health Promotion and Disease Prevention." While parts of this are uncontroversial (smoking cessation programs, paying copayments and deductibles for well baby doctor visits, for example), other parts look like they were added in response to some national gym trade group: "A program that reimburses all or part of the cost for memberships in a fitness center." Perhaps this makes sense--but again: why does this all have to be shoved into a single bill? Lack of confidence that it would survive a straight up or down vote?

And the Elder Justice Act? A quick read through it doesn't seem bad. But again: why not pass this separately, and make the rest of the bill that much shorter, simpler, and easier to understand?

The unseemly haste to get all these separate, barely related, and often completely separable provisions passed makes it look like Congress has something to hide.

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