House reprise, variations and all without needed clarity
On Friday,  I downloaded the Senate's 2,000+ page version of their "Patient Protection and Affordable Care Act," and began reading.  As with the House's reform bill,  key aspects of its structure make it difficult for various constituencies to ascertain effects on them of the proposed system.

Bureaucracy is in evidence from page one, literally. I actually downloaded the Bill twice because, after the first download, it seemed a completely unrelated bill was somehow substituted. The confusion stems from the apparent need to utilize an existing totally unrelated bill (about first-time homebuyers for members of the Armed Forces) as a "work around" to get the actual health care reform bill onto the floor of the Senate.  So, the unrelated bill was used, striking out the bulk of its contents, and substituting in their place the terms for the health care reform bill.  It is tough to admit that for such critical legislation our current system of government required a "work around" from the get go. Not an auspicious start.

For the curious, here is that beginning on page one:


In general, much of the Senate's bill contains the same annoying legalese, lack of page numbering and lack of clarifying footers that are in the House's bill.  There are references and substitutions of fragments of other legislation without full context. If one enjoys reading IRS instructions for doing taxes, one will have the same pleasure in reading this legislation. As with taxes, if this system goes forward, I'm sure an entire industry will evolve to handle explanations, exceptions, processing claims, and requesting subsidies under this new system (begging the question: how will someone afford this help if one actually qualifies for a subsidy?).

The bill mentions implementing a system for rebates when an insurer reports excess profits. Rebates! A system that has scammed many Americans, enough to make the 5 o-clock news on several occasions.  Businesses have made huge profits through the rebate system. Does anyone believe this purchasing ploy would not be here today if it weren't profitable? What is our comfort level, our trust in an industry's reporting system, when we know it would not serve their profit motive?

Reports. This bill has extensive reporting requirements of not only insurers, but of care providers. One wonders who will do all the report preparation as well as the reading of these reports.  Existing personnel?  Or additional hires?  All this reporting will surely not be done without expense.   And who is going to bear the burden of that expense? (Directly or indirectly.)  Perhaps we can take heart in that more jobs will be created, however tedious and time consuming they may be.  And, we may experience first hand the expression "death by a thousand paper cuts."

There are references to platinum, gold, silver, bronze and yet another plan that does not even get a "medal" rating.  Perhaps, as my father used to say, it won't be worth "a plug nickel." More disturbing than this built-in class structure for care, we, as individuals, cannot determine where we might be in this picture or how we will navigate through the system.  One cannot specifically determine what will be available, nor what it will cost.  Or, if the full system will become for each of us (depending on our geographic location) simply irrelevant.  One might live potentially in a State that could refuse to have an "insurance exchange."  Yet, the one thing we can be sure of is that participation will be mandated or we shall be penalized.

As one reads this bill, one experiences a jarring reminder that those who are legislating on our behalf have lived in a privileged and moneyed world.  There is reference to $2,000 and $8,000 deductibles, as if average Americans would deem this type of yearly expenditure "reasonable" in addition to whatever are "affordable" premiums.  Again, "affordability" in the bill is something that will be determined based on "reviews."  The Senate's bill, indicates those who are older can "only" be charged 3 times what a younger person is charged.  (The House's bill, as you may recall, "limited" this ratio to 2 times.)  The lack of definition of what the lower amount would be limited to, however, leaves these ratios on equally nebulous and dangerous footing.

The Senate bill, as with the House's, contains details at a highly specific level for many areas, but conspicuous by their absence are specifics on the details most critical to the average American.  It does not allow an individual to determine, even as an estimate, "What will this cost me?" and "What will I get for that?"

Our clients know that before priorities are set or decisions made, it is imperative that specific understanding be gained about factors or elements of a decision.  Terms, such as "affordable," must be clarified specifically so that all understand and agree with its definition.  Clarifications must go further to ensure that "those who are not in the room" are also able to understand.  "Reasonable" must be defined in terms that are clear, either through references that are clearly understood, or by an example.

Without such explication, there will always be an open invitation for subsequent "interpretation." The arguments that then ensue are guaranteed.  If we could only be assured that this needed clarity would be determined during the three weeks of expected debate in the Senate!  Ah, but this is unlikely. In politics, vagueness is a means of protection.  For politicians, not for the people served.  Obscurity is introduced to "reach agreement across the aisle." A most dangerous maneuver. Vagueness is not a solution.  My Irish friends often quote a saying that when one tries to sit on two stools, one falls in between.