To read the Czar’s review of HR 3200, pages 201-300, please click here.

Welcome back!

Mastermind correspondant Jeanne asked the Czar about reimbursing early retirees’ medical claims (particularly unions or public sector employees…even those at a non-federal level). The Czar maintains that probably isn’t the intent, but Jeanne is right: there is nothing stopping almost anyone from retiring early and having the taxpayers pick up the tab for his or her medical costs. That’s how badly this bill is written: there are very few prohibitions from abuse; instead, there are copious invitiations.

Pundette asked the Czar if there exists the possibility that an assessment of your income level could be done (a financial review) to determine your pre-ability to pay. As with most of this bill, it cannot be confirmed or denied. For example, §1152 (b)(4), covering post-acute care, allows for a review to determine if payment rates can be offset by geographic differences in wages. The likely intent is that poorer areas of the country might get more help, but the wording does not prohibit a more intrusive review. There’s nothing to stop it at all, in fact the phrase “appropriate assessment instrument” can mean anything someone wants it to. Heck, a local provider could unilaterally demand to review your financial background and be in accordance of this law.

As far as determining how far these assessment instruments will go, the taxpayers will pay $15 million per year for three years to figure it out. $45 million just to figure out how to save money on post-acute care payment assessments. The Czar has a fast way to save $45 million: don’t do this.

As the Czar reads through the numerous changes to the Social Security Act (which continue throughout this section!), he is struck by one of two possibilities. Either someone has every word of 42 USC 1395 memorized and down, or this entire package was written and researched a very long time ago, refuting the claim that Waxman slapped this together in his office over a weekend, with the conclusion being that this bad piece of legislation is actually the best Democrats could come up with over at least eight years of effort. Which is it? The Czar leaves it up to the reader.

Another observation. The bill really tries to list as many variations of Medicare and Medicaid-like programs as possible from the Social Security Act. Instead of simply copying those into this bill, why not reform them? How about collapsing them? The only reason they are/were broken out in the Social Security Act is because they were new additions not previously encompassed by the Act. Instead of listing them all again, with all the repetition for each regarding reporting, funding, verification of claims, etc., which are largely identical for area to area, how about putting them under an umbrella? Maybe because no one thought of it?

Page 325, line 23: There shall be no judicial review of Secretary of HHS decisions on incorporating home health services improvements into the public health system? Why not? Maybe because no one thought this would be a good idea to prevent abuse?

Here’s one for Conyers: “The Secretary…shall notify the Medicare Advantage organization that is offering a high quality plan or an improved quality plan of such identification for the year and the quality performance payment adjustment for such plan for the year.” The next sentence cheerfully adds that this helpful bit of writing will also appear on the Secretary’s website. Just click on the WTF? link (page 341, lines 10-20).

And large amounts of 301-399 are filled with good stuff like this. The Czar would like proponents of Obamacare to answer what these items specifically do to improve healthcare coverage for all Americans:

1. §1203(a)(1)(iii): For purposes of applying this section,an individual shall be permitted to apply on the basis of self-certification of income and resources; and matters attested to in the application shall be subject to appropriate methods of verification without the need of the individual to provide additional documentation, except in extraordinary situations as determined by the Commissioner.

2. §1204(b)(3): For each month beginning with January 2011, each prescription drug plan and each MA–PD plan shall report to the Secretary the following: The number of claims the plan has readjudicated during the month due to a beneficiary becoming retroactively eligible for subsidies available under section 1860D–14 of the Social Security Act.

3. §1207(a): In general.—Section 1860D–14(b)(2)(B)(iii) of the Social Security Act (42 U.S.C. 1395w–114(b)(2)(B)(iii)) is amended by inserting before the period the following: “before the application of the monthly rebate computed under section 1854(b)(1)(C)(i) for that plan and year involved”.

The vast majority of educated Americans will not make any sense of this. If your doctor spoke like this, you would get another doctor, right? So if your congressional legislators are writing like this, you might consider getting different legislators, right?

Look, it’s pefectly simple. This is a pastiche of various liberal-leaning programs that have been slapped together the moment Obama won the election. No one has written this: it’s all be copy and paste stuff. Each author has trusted the author before him to do the fact-checking. As a result, this entire document is a vast mess. Sections make no sense, might contradict others, and allow for no end of creative interpretation at the taxpayer’s expense.

The Czar believes that the ordinary American supporting this initiative has not read the proposals. If he or she did, that ordinary American would say “There is no way I am entrusting my healthcare to this group. I can’t even understand what the hell they’re saying.” When you applied for healthcare coverage with your employer, do you remember how many pages the information was? Two? Three? Four? And a lot easier to understand than this stuff.

Evidently, the people who wrote it do not understand what they have written in its entirety, but worse, they think they do. But they don’t understand it anymore than the admin assistant understands the legal contracts he or she photocopies for an attorney waiting in another conference room.

Be afraid, folks. Because the only people who really do understand this stuff will be the first ones to twist it to their financial advantage.

To read the Czar’s review of HR 3200, pages 401-500, 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.