More on HEALTH CARE

In follow up to HEALTH CARE here are some legitimate questions that Congress and “We the People” should be asking and demanding answers for.

Lee Cary at American Thinker has set forth these very troublesome questions to OBAMACARE and I take the opportunity to share them here with you.

*(Page 30) According to Section 223, Payment Rates For Items And Services, “The Secretary [of the Treasury] shall establish payment rates for the public health insurance option for services and health care providers consistent with this section and may change such payment rates in accordance with section 224.”

Also, according to Section 225, Provider Participation, there are two schedules of payment terms for physicians. Preferred Physicians “agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.” And, Participating, Non-Preferred Physicians “who agree not to impose charges…that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act.

Section 1848(g)(2)(C) reads: “(C) After 1992.—For physicians' services furnished in a year after 1992, the 'limiting charge' shall be 115 percent of the recognized payment amount under this part for nonparticipating physicians or for nonparticipating suppliers or other persons.”

SO, Timmy Geithner will be responsible for deciding how much physicians make? (How does he do that when he can’t accurately calculate his own taxes?) What’s the projected cumulative impact on the income of U.S. physicians?

*(Page 167) Section 59B, Tax On Individuals Without Acceptable Health Care Coverage, “In the case of any individual who does not met the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of (1) the taxpayers’ modified adjusted gross income for the taxable year, over (2) the amount of gross income specified in sections 6012(a)(1) with respect to the taxpayer.”

SO, why is this plan sometimes referred to with the words “health care choices” when my only choices are to comply or pay a tax penalty? Exactly what are these “choices”?

*(Page 170) According to Section 59M (p. 171), “(2) Nonresident Alien. Subsection (a) [pertaining to the tax on individuals without acceptable health care coverage] does not apply to any individual who is a non-resident alien.”

SO, who pays for the health care for those in the U.S. on J-1 and F-1 visas? We citizen taxpayers?

(Page 59) Section 431, Disclosures To Carry Out Health Insurance Exchange Subsidies, amends section 6130 of the IRS Code of 1986 with language that enables the Health Choices Commissioner [in a previous installment of this series referred to as the “Commish”] access, via written request to the Secretary of the Treasury [Timmy Geithner], to taxpayer records including: “(i) taxpayer identity information with respect to such taxpayer; (ii) the filing status of such taxpayer; (iii) the modified adjusted gross income of such taxpayer; (iv) the number of dependents of the taxpayer; (v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof)…”

SO, with my tax information available within the enormous bureaucracy required to stand-up “America’s Health Choices Act of 2009” how long before this information becomes available to operatives of the political party in power at the time? And, when can we expect affluent citizens to be denied government healthcare payment because their net worth is identified as beyond a certain level? Oh, and by the way, just how many more government employees will be hired to staff Obamacare? And, of what government workers’ union are they likely to become members?

: (Tracking through this one will hurt, but it’ll pay off - at the very end.) The Obamacare bill makes amendments to the Social Security Act (SSA), thereby requiring the reader to toggle back-and-forth between the two bills, as well as the IRS Code. Here goes:

*(Page 42) SSA, Section 1848, Subsection (j) reads as follows:
“(1) Category.—For services furnished before January 1, 1998, the term ‘category’ means, with respect to physicians' services, surgical services (as defined by the Secretary and including anesthesia services), primary care services (as defined in section 1842(i)(4)), and all other physicians' services. The Secretary shall define surgical services and publish such definitions in the Federal Register no later than May 1, 1990, after consultation with organizations representing physicians.

(2) Fee schedule area.—The term ‘fee schedule area’ means a locality used under section 1842(b) for purposes of computing payment amounts for physicians' services.

(3) Physicians' services.—The term ‘physicians' services’ includes items and services described in paragraphs (1), (2)(A), (2)(D), (2)(G), (2)(P) (with respect to services described in subparagraphs (A) and (C) of section 1861(00)(2)), (2)(R) (with respect to services described in subparagraphs (B), (C), and (D) of section 1861(pp)(1)), (2)(S), (2)(W), 2(AA), (3), (4), (13) (14) (with respect to services described in section 1861(nn)(2)), and (15) of section 1861(s) (other than clinical diagnostic laboratory tests and, except for purposes of subsections (a)(3), (g), and (h) such other items and services as the Secretary may specify).

(4) Practice expenses.—The term ‘practice expenses’ includes all expenses for furnishing physicians' services, excluding malpractice expenses, physician compensation, and other physician fringe benefits.”

Now, the pending House version of the healthcare deform, oops, reform bill proposes (in Section 1121, pages 241-244) to add a 5th paragraph to the SSA that reads as follows:

“(5) Service Categories.-For services furnished on or about January 1,2009, each of the following categories of physicians’ services (as defined in paragraph (3)) shall be treated as a separate ‘service category’ (A) Evaluation and management services that are procedure codes (for services covered under the title for – (i) services in the category designated Evaluation and Management in the Health Care Common Procedure Coding System (established by the Secretary under subsection (c)(5) as of December 31, 2009 and as subsequently modified by the Secretary); and (ii) preventative services (as defined in section 1861(iii) for which payment is made under this section. (B) All other services not described in subparagraph (A). Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.”

[Here, as elsewhere in life, the devil is in the details – sometimes the last detail.]

SO, as the incomes of physicians who specialize are brought, by this bill, into income equivalency with general practitioners (AKA family practice or primary care physicians), how will that impact the incentive for med students to specialize by undertaking years of additional training, often incurring substantial additional medical school debt and deferred income? Do primary care physicians represent a disproportionate percentage of the physicians that supports this bill?

Why aren’t these questions being asked?

Footnote:

*(PAGE numbers correspond with earlier post on HEALTH CARE)