To read the Czar’s review of HR 3200, pages 101-200, please click here.

Meanwhile, let’s get going and plow into pages 201-300.

Poor Ronald Reagan. Perhaps you remember, as the Czar does, the astonishing Tax Reform Act of 1986. This is when Reagan was unquestionably leading a massive economic boom as well as delivering a death blow to the Cold War. The GOP owned both sides of Congress, and as a result, the nation’s tax laws were reformed in a way that cemented our economic growth right into 2008. People loved this at the time: their taxes actually dropped significantly.

Now the tables are exactly opposite, and the Democrats are using HR 3200 to, they hope, make sweeping changes to the TRA of 1986. There are an ungodly amount of references listing corrected, amended, revised, and deleted sections to the TRA, not all of which are easily deciphered to see if they even apply to healthcare reform.

Finally, at page 215, we finally stop with the bloodletting of Reagan’s tax reforms…and get right into Division B: Medicare and Medicaid Improvements!

Sure. Now that we’ve made wholesale changes to the Tax Reform Act of 1986, it’s time to fix those gaping errors which that conservative nut Roosevelt left in the Social Security Act. Quick, before we run out, find something else that’s been reformed so we can use Healthcare as a premise to insert our radical progressivism into it!

(It’s good to delete and correct items pulled out of other acts merely by referencing the specific words you want changed. It makes it very difficult to look them up to see what the implications are.)

Gotta love things like this: §1103. Incorporating Productivity Improvements Into Market Basket Updates That Do Not Already Incorporate Such Improvements. Why, we’re fixing things that nobody thought were broken!

For example, here’s (page 225, lines 3 and following) how the Democrats will improve Medicare and Medicaid: “The productivity adjustment described in this subclause, with respect to an increase or change for a fiscal year or year or cost reporting period, or other annual period, is a productivity offset equal to the percentage change in the 10-year moving average of annual economy-wide private nonfarm business multi-factor productivity (as recently published before the promulgation of such increase for the year or period involved). Except as otherwise provided, any reference to the increase described in this clause shall be a reference to the percentage increase described in subclause (I) minus the percentage change under this subclause.” As they said to Gabby Johnson in Blazing Saddles, who can argue with that?

Check this out: On page 229, lines 7-17. ” [T]he Secretary of Health and Human Services shall…for skilled nursing facility services…increase payment by 10 percent for non-therapy ancillary services…and shall decrease payment for the therapy case mix component of such rates by 5.5 percent.” The Czar deleted a lot of Social Security Act cross-references here, so that you could see the words that matter. The Czar is not sure what a 10 percent increase for non-therapy ancillary services could be, but in a skilled nursing facility, that means things like the beauty shop, the cafeteria, and computer training. Therapy case mix components is a fairly obscure Medicare term that describes patients who need a combination of occupational, physical, and speech therapy. So your tax dollars will increase payments to things like manicures, but decrease money available to therapy programs that actually make skilled nursing patients recover. Unbelievable. The Czar put his grandmother into an attic for a decade, but if he had put her into a skilled nursing facility, he would prefer she spend her time getting physical therapy rather than a second cup of fruit salad at lunch.

By about page 252, you begin to realize the SecHHS has a lot of work to do in reviewing all these payments, adjustments, services, and misvalued codes. One assumes the Secretary will need to hire a lot of staff members to keep up with all this. It’s like some Democratic congresspeople sat around an org chart of the executive departments and said, “Hey, you know…Health and Human Services hasn’t really increased in size like the other departments. We need to bump them up a little.”

Now check out §1123. Payments for Efficient Areas. The Czar had to insert the definition of “efficient areas” into the following to merge two paragraphs into one sentence, but otherwise this is what was written: “In the case of services furnished under the physician fee schedule…by a supplier that is paid under such fee schedule in an efficient area ([those counties…in the lowest fifth percentile of utilization based on per capita spending…for services provided in the most recent year for which data are available as of the date of the enactment of this subsection]), in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 5 percent of the payment amount for the services under this part.”

In other words, if you are a county that proves to be very good at saving taxpayer dollars, the government will write you a bonus check every month for 5% of the money that you do spend. Just a thought: how about you save the taxpayers 5% and not send them any money every month or quarter? You actually need to have an incentive program for a government system? Why? Afraid that some folks won’t buy into the money saving bit? Oh right—you want to punish McAllen, Texas. Almost forgot.

Naturally, there comes §1124. Just as §1123 covers the Democrats’ backsides by punishing counties that show how screwed up ObamaCare is, §1124 needs to prove the administration’s claim that ObamaCare physicians will be able to handle more patients than ever by reducing time spent on needless tests. The PQRI, or the Physician Quality Reporting Initiative, will issue report cards on doctors who can speed through exams, and even offer them incentive payments for backing the program rather than spending whatever time is necessary per patient (p. 260, line 7ff). Sound familiar? If not, read one paragraph up.

Hey, you know those Scooter commercials, where the owner of the company promises that Medicare will pay for 100% of the cost of your motorized wheelchair or they’ll eat the difference? In §1141, the phrase “power-driven wheelchair” shall now be replaced in the Social Security Act with “complex rehabilitative power-driven wheelchair.” In other words, if you don’t specifically need the motorized chair for complex rehabilitation, Obamacare says you can freaking walk or crawl from now on. Or pay for it yourdamnself. On the one hand, the Czar can see how this is a claim to save money—right, GOP? Why do those pesky elderly folks need taxpayers to help them live normal lives? On the other hand, there’s something wickedly disingenuous about this. If AARP lived up to its name, this would be the first thing to decry.

Section 1146 mentions that $8 billion will be set aside for a Medicare Improvement Fund. New bell in the tower? New roof for the library? New playground? Any ideas where this $8B is going?

Section 1149 establishes a need to for an advisory commission to conduct a bone mass measurement study, including duel-energy x-ray absorptriometry. Duel energy? Like when the two dudes in Big Trouble in Little China were shooting colored light out of their hands at each other? Awesome! Or it could mean that no one can spell dual? The Czar hopes it is the former, because there is no point or explanation for why this study in particular is essential to making healthcare affordable for all Americans.

Page 280. Aha! §1151 covers Reducing Potentially Preventable Hospital Readmissions. What could this mean? Well, the first thing that comes to mind is to continue doing what doctors do today: they schedule a battery of tests to make damn sure they know the entire scope of treatment, and thereby hope to avoid missing something that brings you back in. However, the Czar doubts this is what the proposal has in mind.

True to form, the proposal simply makes the SecHHS responsible to review readmissions and determine if there are any glaring patterns that could be preventable. As far as saving taxpayers money, the SecHHS will fortunately make recommendations that improve efficiency of the entire system, whatever those may prove to be.

In summary, pages 201-299 cover a lot of Democratic rewrites of both the Tax Reform Act of 1986 (back when the Dow was under 2,000, if you want a perspective on how the Reform Act changed the world) to the Social Security Act. Then, we see how some of the money is being spent: on strange activities, on non-healthcare items, on rewarding people who don’t use the system, and on unspecified improvement funds. Bottom line: this portion of HR 3200 exists mainly to introduce some Democratic backlash for the success of the GOP over the years.

And one wonders…what will the next 100 pages reveal?

To read the Czar’s take on pages 301-400, please click here.

The Czar of Muscovy

Божію Поспѣшествующею Милостію Мы, Дима Грозный Императоръ и Самодержецъ Всероссiйскiй, цѣсарь Московскiй. The Czar was born in the steppes of Russia in 1267, and was cheated out of total control of all Russia upon the death of Boris Mikhailovich, who replaced Alexander Yaroslav Nevsky in 1263. However, in 1283, our Czar was passed over due to a clerical error and the rule of all Russia went to his second cousin Daniil (Даниил Александрович), whom Czar still resents. As a half-hearted apology, the Czar was awarded control over Muscovy, inconveniently located 5,000 miles away just outside Chicago. He now spends his time seething about this and writing about other stuff that bothers him.