A week or so ago, I contacted my Congressman Kurt Schrader. His office sent me a message back, telling me why he supports HR3200. Below is my response.

Mr. Schrader,

Thank you very, very much for responding to my email. I appreciate you sending me information about HR3200. My own reading of the bill is what prompted me to contact you.

I have very serious concerns about this legislation.
You wrote,

"In HR 3200, healthcare reform revolves around guaranteeing everyone a basic level of healthcare in America. Every new or modified health plan 4 years from now must cover hospitalization, outpatient care, doctors and other health professionals, equipment and supplies needed for physician authorized care, prescription drugs, rehab services, mental health services, preventative services, maternity care and well baby and child care (including dental, vision and hearing up to age 21). A broadly representative Health Benefits Advisory Committee chaired by the Surgeon General will develop the details of the basic services with public input. Everyone and every business must share in the cost of their own healthcare services except the extremely poor, generally those under 133 percent of poverty level (about $14,400 for an individual), or the very small business with a payroll under $500,000 (originally $250,000, amendments proposed have raised the level)."

Since I am a male and will never become pregnant, and my wife is unable to have children, why would our insurance be FORCED to cover "maternity care" and "baby and child care"? Why does my employer as well as our family have to pay for a mandate that WE WILL NEVER USE? Also, why would "every business" be forced to "share in the cost" of health insurance? Why not let the business decide if they want to offer health insurance? Businesses do not "share in the cost" food, clothing, nor shelter with their employees, yet these things are just as important, if not more so than health insurance.

You said,

In addition to Medicare, healthcare delivery in HR 3200 will be through three major options regulated by an overarching Health Exchange to make sure the system is working correctly and everyone is playing by the rules. Private insurance will still provide the bulk of healthcare access in the House Plan. After 10 years the Congressional Budget Office estimates that employer-based coverage does not change very much at 58 percent of health care coverage for Americans. Non-group and other health plans will cover 9 percent. A new "Public Option" will cover 10 percent and Medicaid/Chip 16 percent. Approximately 7 percent will remain uninsured including unauthorized immigrants and those choosing to opt out.

The CBO also estimated that HR3200 would cost $1.04 TRILLION over 10 years. So you are telling me that we are going to spend over a trillion dollars to cover only an additional 8% of America? Also, there is no enforcement mechanism in HR3200 to make sure illegal aliens are not covered by the new "public option." Not that they need it at any rate. The law already forces hospitals to treat anyone who comes in, for almost any reason. Moreover, many in Washington D.C. want to give illegal aliens amnesty, so whether HR3200 covers "illegal aliens" may be moot. In reality, hospitals and clinics are becoming overwhelmed by large number of largely poor illegal immigrants coming to receive free care.

You said:

All employers with a payroll over $500,000 must provide healthcare or pay a graduated payroll tax starting at 2 percent going up to 8 percent for higher payrolls. Very small businesses with 10-25 employees whose average wage is less than $20,000 to $40,000 will be eligible for up to a 50 percent tax credit to help them provide coverage. The employer is responsible for 72 percent of the cost for his employee or 65 percent if also covering the employee's family. The employee contributes the remainder. Employers may opt to get their insurance under the exchange or with another private plan. Private and public plans are allowed under the exchange.

Since health insurance often costs more than 8% of payroll (According to the Kaiser Family Foundation, in 2005 the average percentage of payroll paid in health insurance costs was 11%), why wouldn't they simply drop their coverage and let the government pay for it? HR3200 WILL lead to a single payer system in the end. Please stop lying to us and tell us the truth.

Individuals can get employer-based healthcare through their employer as outlined above or get care on their own including through a public option provider. If an individual does not get health insurance he is penalized 2.5 percent of his adjusted gross income. "Affordability credits" will be given to people on a graduated basis with incomes up to 400 percent of poverty ($88,000 for a family of four), with non-employer based healthcare to help them pay for their share of their health insurance. Out of pocket expenses above the premium are limited to $5000 per individual and $10000 per family adjusted for the consumer-price-index.

So every single American will be forced to buy health insurance, with absolutely no provision to control costs? Since when do we in America punish personal choices in lifestyle? Surely this is not in keeping with the title of HR 3200, part of which includes the word "Choice."

The public option will be offered by 2013. It must compete on a level playing field with private plan choices. It will receive no taxpayer assistance other than a loan for start up costs which it has to repay over 10 years. It will have to negotiate its own rates (not tied to Medicare according to recent amendments), maintain reserves and pay its own administrative costs.

Social Security, Medicaid, and Medicare are also suppose to fund themselves. None have ever done so, and in fact, ALL of them are a great burden on our budget. Since there is nothing in HR3200 to control costs, how can you guarantee it will pay for itself? In truth, you cannot.

Childless, able-bodied poor adults (under 133 percent of the poverty level) are added to Medicaid with 10 percent cost sharing with the states (originally 7 percent). Medicaid and Medicare benefits are not reduced. Many efficiencies, productivity improvements and anti-fraud/waste measures are affected in the bill that save billions of dollars and provide better service for the individual, provider and insurer. The "doughnut hole" in Medicare prescription drug coverage is reduced $500 in 2011 and completely phased out by 2023. Asset tests are eased, application and reimbursement improved and physician Medicare payments elevated so that physicians can afford to take on senior Medicare beneficiaries. Training and transparency in nursing home care is made a priority as well.

So benefits are not reduced, payments to doctors are increased, income tests are "eased," and there will be more government oversight, and you are promising to "save billions of dollars?" Are you serious? Government can do many things, and does some things well. Reducing waste and fraud is not one of them. We have been promised for decades that fraud would be investigated and dealt with in Medicaid and it has not happened. Why would we think "this time things will be different"? Until fraud is ended in Congress itself (please start with Charles Rangel and his tax "issues"), Congress will be in no position to enforce "efficiencies, productivity improvements and anti-fraud/waste measures."

HR 3200 recognizes that improving access requires investments in adequate primary and care providers to handle the increased caseload. The House bill encourages graduate medical education, expands loan repayment provisions for the national health service corps, recognizes America's rural needs for healthcare professionals, not all of whom have to be physicians, promotes training in family, general internal and pediatric medicine, geriatrics, dentists, and physician and dental assistants and nurse practitioners. Scholarships and loan repayment programs are expanded for students aspiring to a career in primary care especially in underserved areas.

In fact, HR3200 includes the racist practice of giving preference in "medical education" to minorities, under the euphemism of "underserved areas." Please include incentives for ALL Americans, not just those who have a certain skin color.

Public health, community based health centers and school based health clinics are expanded. Preventative care strategies with evidence based results are to be developed. There will be no co-pay for preventative healthcare and primary care providers will be reimbursed for providing you care and information at 100 percent of the cost. Expanded delivery of public healthcare and preventative care are recognized as ways to curb the long term healthcare cost curve thereby reducing costs to individuals and the system as a whole while providing a healthier life.

These are lofty goals, but how will expanding payments help reduce costs?

Oregon should benefit from the emphasis on quality not quantity of care embedded in the bill. Oregon and some other states have historically been penalized in their reimbursement rates from the federal government for providing high quality, low cost care. Forty years ago the original Medicare system was based on the "fact" that healthcare just costs more in some states. That is simply not true in today's national and global economy. Dartmouth, OHSU and others can document Oregon gets only half the reimbursement of other high cost states that deliver poorer health outcomes at greater expense. An amendment to the base bill provides that over the next three years the federal government transition from a strict fee-for-service payment schedule to one that recognizes good outcomes. Oregon will also benefit from the emphasis on accountable care organizations, medical home delivery systems, pay for performance incentives, evidence based research on best procedures, medications and delivery systems because we are already pioneering in these areas.

I suppose gasoline should cost the same in Hawaii as it does in Oklahoma as well? It is false to claim that healthcare costs the same in all states simply because of the "national and global economy." There are far, far too many variables to make that kind of blanket claim. If the government attempts to centralize health care, it will be a disaster.

About half of the cost of the House healthcare bill comes from efficiencies in our current Medicare and Medicaid system as referenced earlier. The other is from a surcharge on those families earning over $350,000 adjusted gross income ($280,000 for an individual). It is estimated that the surcharge would apply to only the top 1.25 percent of earners today. The Congressional Budget Office (CBO) has not responded favorably to the House Bill controlling long term costs. However, CBO has concerns that the bill as originally written actually increases long term costs given the improved access and subsidies given to individuals and businesses. CBO does not give credit in its formulas for the potential long term benefits of improved public health, preventative care, and moving to a quality based versus quantity based reimbursement methodology for providers. Nevertheless, the long term cost issues identified need to be addressed before final passage.

I trust the non-partisan CBO much more than Congress. They have no incentive to mislead people in order to garner support and votes. Also, why do we always ask the successful to bear a greater burden of the costs of societal programs? Why not equally share the costs among everyone? Better yet, why don't we ask those who make the most use of the services to ACTUALLY PAY FOR THE SERVICES THEY MAKE USE OF? If I buy a cell phone plan, would I ask people who are rich to pay for it? Why not?

As HR 3200 advances through the legislative process, I will follow it closely and take your concerns into consideration prior to any action.

Please do. I would urge you to vote "no" on this terrible legislation. Please start over, looking for ways to reduce prohibitive regulation to increase choice (not reduce it), frivolous lawsuits, and ending non-emergency medical services for illegal aliens.

Thank you again for contacting me and should you have any further questions or concerns, please contact my office by calling (202) 225-5711 or 1-877-301-KURT. To keep updated on my activities and to contact me through email, please visit my website at: www.schrader.house.gov.

Sincerely,

KURT SCHRADER

Member of Congress

Thank you for keeping me informed. I look forward to you rejecting this legislation and working on reforms that will actually reduce costs, while expanding choice.

Sincerely,

Robert Drouhard,

Salem OR.

Unfortunately when I sent this email, I got the message:
"Google tried to deliver your message, but it was rejected by the recipient domain."