How Legislation Will Impact You
Commentary by Daniel T. Zanoza, Executive Director
In 2006 I became totally blind. I don't need to go into the details involving what led to the loss of my eyesight, but because of my experience, I am familiar with how Medicare and Medicaid work in Illinois. I also understand how the proposed health care reform bill--which cleared a major hurdle due to a procedural vote taken in the United States Senate on Monday, December 21, 2009 at roughly 1 A.M. Central time--would impact those currently receiving Medicare and Medicaid.
Without going into the minutiae regarding parliamentary rules, the vote taken in the U.S. Senate early Monday morning essentially will mean the bill will be passed in the Senate in its current form sometime later this week. Senate Republicans--who voted en masse against health care reform--have run out of tactics that would delay the official passage of the legislation.
I qualify for and receive Medicare and Medicaid. Medicare covers roughly 80% of doctor and hospital bills; Medicaid (which is funded by the state of Illinois) pays the majority of the balance for essential health related expenses. Rules differ from state to state regarding the Medicaid entitlement, dependent upon one's income, including pensions, retirement funds, personal assets, etc.
Obviously, Medicare is a program that is a safety net for both the rich and poor alike. Without Medicare, health care costs would decimate the financial standing of most Americans. But Medicare was primarily designed to assist the elderly, the handicapped and those who qualify for the program under survivor benefits.
As many know, President Barack Obama's health care reform bill would reduce Medicare benefits by $500 billion. Some say, over a ten-year period, these proposed cuts would come closer to $1 trillion. To put this in perspective, Medicare's budget for a one year period alone is $500 billion. Under Obama's proposal, essentially one year of Medicare funding would disappear. Supporters of health care reform claim the reduction in the program's funding would come from elimination of waste and fraud related to Medicare. I have personally become aware of the fact there is a great deal of wasteful spending in the system. I receive monthly reports on what Medicare pays to doctors and hospitals and--more than once--I have seen things like double and triple billing for the same procedure. But in contrast to Obama's allegations, I have rarely seen doctors prescribe tests that were unnecessary. The truth is, it would not take a massive reform of America's entire health care system to address these problems. In one particular circumstance, I had one stress test performed at a highly renowned hospital in Chicago. The records I received indicated Medicare was billed for the same procedure three times. I called a hotline meant to address Medicare abuse and/or fraud. However, my attempt to report this abuse fell on deaf ears. I even contacted a member of Congress regarding the matter who supposedly claimed abuse of this kind was an issue he was deeply concerned about, but I never heard from this Congressman either. Subsequently, a procedure--which lasted 15 minutes, involving two technicians and a treadmill--cost taxpayers three times the original bill of $600. It's no wonder Medicare will soon be bankrupt.
There are good things about Medicare. I can choose my own doctor, in most cases, although there are some physicians who will not participate in the program. If I need to see a specialist regarding a medical problem I am having, the wait time to get an appointment is reasonable, although there are situations where it can take weeks to get an appointment with a specialist. In general, if the costs from abuse and waste were eliminated from Medicare, it would be an entitlement even fiscal conservatives could live with.
On the other hand, my wife's situation is an example of how Medicare would work under the current reforms proposed by liberal Democrats who control both Houses of Congress and the presidency. My wife no longer works and she has no health care insurance. Since I lost all my vision, she is reluctant to leave me alone, for even short periods of time, even though I tell her "I will be okay." The reaction of a loved one in such a situation is understandable because if the circumstances were reversed, I would react in the same manner, probably to a greater degree.
Under Medicaid guidelines in the state of Illinois, I am caught in a Catch 22. My wife is not covered under Medicare or Medicaid and we cannot afford health care insurance for her. Subsequently, my wife must pay for her doctor visits, tests and any medications. She is enrolled in a program at a clinic which accepts patients with little or no income. The facility is located in Springfield. A round trip to the clinic is roughly 80 miles and, most important, the wait time to see a doctor is often six weeks or longer. This program is not free. The amount one is charged is dependent upon a family's income. Therefore, my Social Security benefits are included as income and my wife is charged according to a sliding scale. If tests, x-rays, etc. are needed, (and they require a referral from the attending physician at the clinic), again, costs are determined on a sliding scale. Such referrals are dependent upon finding a doctor who is willing to participate in the program. Many physicians and specialists do not accept such referrals, due to the fact the Medicaid program in Illinois is extremely slow in making payments. The Medicaid program in Illinois is an unfunded mandate which, in great part, has resulted in multi-billion dollar deficits facing the state. This scenario is repeated in many other states across the nation.
If health care reform is passed by the United States Congress, it will include at least 30 million individuals, like my wife, who do not have health care insurance. The proponents of health care reform claim the legislation--which would essentially put one-sixth of the American economy under the government's control--would be deficit neutral. A simple question that must be asked is:
How will 15 million, 30 million or 47 million people (depending on what numbers you believe) who are currently without health care insurance receive adequate health care without it costing taxpayers literally, in some cases, an arm and a leg? When health care reform is passed, no matter which version of the bill it will be, there are some realities that will have a great impact on all Americans--for generations to come.
There will be rationing of health care services for those who qualify for Medicare. Any one who believes this will not be the case is either naive or grossly ill-informed. Then, there is the most likely scenario which will result in the government taking further control of our daily lives. Americans will be told what they can eat or drink. We will be told we must live what some bureaucrat will determine is a healthy lifestyle. Though the left claims health care reform is meant to benefit the poor, it will, in actuality, hurt, not help low income families.
I, as an individual who qualifies for Medicare, expect health care services (under any legislation currently being considered by Congress) to be delivered in a clinic-like form of the type my wife is currently enrolled in. Now, of course, I don't expect to be sitting in a waiting room alongside my wife, Oprah Winfrey, Michael Jordan or Warren Buffett. With millions of baby boomers reaching the age of retirement, the current system will collapse under its own weight. Subsequently, there will be a class of citizens--mostly made up of the wealthy--who will be able to choose their own doctors and receive the care provided to those who qualify for Medicare as it now exists. Then, there will be a vast majority of the public who will be subjected to a grossly inferior health care delivery system. Many more doctors will refuse to accept Medicare patients because of the bureaucracy involved. The fiscal demands related to the supposed inclusion of the uninsured into the health care system will drive many physicians who are specialists out of the system because the government will not pay for procedures unless they are approved by bureaucrats in Washington, D.C.
Here is an example of how rationing will work. Recently, a very controversial recommendation made by a board of government "experts" suggested women between the ages of 40 and 49 do not need yearly mammograms. Though this procedure has saved the lives of countless women by detecting breast cancer in its early stages, government bureaucrats, not doctors, will determine the fate of untold millions. Such boards will be created to determine what other procedures, i.e., tests, x-rays, surgeries, etc. are necessary. We must keep in mind one of the primary reasons for the recommendations regarding yearly mammograms for women between 40 and 49 not be performed was supposedly based on the anxiety women face when waiting for the results of their mammograms. The recommendation of the board was met by condemnation from those on the left and the political right--and rightly so. However, under health care reform, such ridiculous findings will be commonplace, rather than an anomaly.
After the Senate passes its version of health care reform, the Senate version of the bill and the legislation already passed by the House of Reps. will undergo the committee process where some sort of compromise must be reached. The final product will again come before both Houses of Congress for a final vote and if passed, the bill will then be brought to Obama's desk for his signature. There is still time for health care reform legislation to be defeated. The vote taken by the Senate in the dark of night, while most Americans were sleeping, was a huge step in the process of ramming health care reform down the throats of the public.
Unbelievably, many Senators who voted for the bill, including Democratic majority leaders like Illinois Senator Dick Durbin, did not even take time to read the bill they voted to pass.
However, the results are not a fait accompli. Yet there are forces, including the pharmaceutical industry and lobbyists representing many different special interest groups (except for those who wish to make America's health care delivery system better) who will apply extreme pressure that will ensure health care reform becomes a reality. This is despite the wishes of a vast majority of the American public who can look at the issue objectively.
Many Americans admit there is a need for health care reform. Many individuals, my wife included, do need some form of medical care, besides visiting an emergency room for a slightly sprained ankle. A common sense approach to the problem is needed, but common sense rarely is the driving force in Washington, D.C. If I thought health care reform would benefit anyone, I would be for it. However, in the real world, the result of this legislation will not improve anyone's health care, including my wife's. There will come a time when those now on Medicare, especially the elderly, will look back at the "good 'ol days" when the money they paid into the system for their entire lives ensured decent medical care.
Here is a crazy idea. Perhaps a board consisting of average Americans, including people from all walks of life, could be put together to devise a plan that would not only bring health care costs down, but improve health care for those who need it. But such a board would need to exclude politicians, lobbyists and the special interest groups they represent. However, don't expect that to happen any time soon. Though nearly 60% of Americans oppose the health care bills currently being considered by both Houses of Congress, our elected officials are going forward with their plan any way. The message is: We are going to help you whether you want the help or not, no matter the cost or consequences to our country.
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