ObamaCare: The Good, the Bad, the Ugly, and the Ignored – Part 3

In Part 1 of this series I listed things in the house version of ObamaCare (H.R.3200) that I think are conceptually worthwhile and also some conceptually bad. Part 2 highlighted parts of H.R.3200 that are downright ugly. Part 3 adds to the downright ugly list.

The Ugly - Continued

4. Health Choices Administration: - Section 203 requires the Health Choices Administration to “specify the benefits to be made available under Exchange-participating health benefits plans”.

5. Coercion of Employers: - Section 313 requires additional payroll taxes of 8% of payroll on employers that do not provide qualified health insurance (QHBP). This tax is to be paid to the Health Choices Administration.

6. Advanced Care Planning Consultation: - Section 1233 requires “advance care planning consultations” if the patient has not had such a consultation with a health care practitioner in the past five years. “Advance care planning consultations” include

“An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such supports that are available …”

7. Patient Decision Aids: - Section 1236 establishes a demonstration project in which health care providers “shall routinely schedule Medicare beneficiaries for a counseling visit after the viewing of such a patient decision aid … and to assist the beneficiary in thinking through how
their preferences and concerns relate to their medical care”.

Patient Decision Aid is defined as “an educational tool (such as the Internet, a video, or a pamphlet) that helps the patients (or, if appropriate, the family caregiver of the patient) understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.”

Shared Decision Making is defined as “a collaborative process between patient and clinician that engages the patient in decision making, provides patients with nformation about trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan.

The wording of this section seems harmless but it is mandated, the results are to be recorded and submitted to a government agency - the Health Choices Administration, and the overarching purpose is to reduce the cost of health care. This adds up to a conceptually useful tool that is likely to used as a weapon to convince, cajole, and shame Medicare patients into “taking a pill instead of having the operation” in President Obama’s words.

There’s still more ugly to report in future posts.

Links to Other Topics in the Special Report: Universal Health Care