Now that the deed ‘tis done, how will it affect you? (Part I)

March 22nd, 2010 by MOTHAX

Lots of heated rhetoric floating around out there, and I want to leap in. [Part II of this will discuss the effects that this will have on the VA.] The big question everyone has is: how will this affect me, the VA/TRICARE/TRICARE-for-life individual? Well, let’s start by looking at what some of the others are saying, and then try to cut the middle. Separate the wheat from the chaff, as it were. The only folks I have found thus far that think this thing is just great for veterans and their families is VoteVets. Now, mind you the MoveOn.org affiliated group is also citing some Harvard study of how many veterans die without health insurance that is based on nothing but comparing the number of deaths with the percent of veterans, so take it for what it is worth:

The right has spent a good portion of the debate over health care reform engaging in scare tactics aimed at Veterans and Retirees (and when not doing that, have engaged in the demonizing of government health care begging the question why our Veterans would get health care that is somehow substandard, but I digress). Today, VA seeks to put those fears to rest… [Duckworth statement that deals with VA] The author of that statement is, of course, Tammy Duckworth, Assistant Secretary of Veterans Affairs, a double combat amputee who left both her legs in Iraq. As the vote on health care reform draws near, expect to see more shameful fear-mongering directed at the Veteran community-- a slimy political tactic that falls well beneath the measure of service Vets have given to our country.

Now, not long after that, VFW went live with its statement:

"The president and the Democratic leadership are betraying America's veterans,” said Thomas J. Tradewell Sr., a combat-wounded Vietnam veteran from Sussex, Wis., who leads the 2.1 million-member Veterans of Foreign Wars of the U.S. and its Auxiliaries. “And what makes matters worse is the leadership and the president knows the bill is flawed, yet they are pushing for passage today like it’s a do-or-die situation. This nation deserves the best from their elected officials, and the rush to pass legislation of this magnitude is not it.”

And of course, VoteVets returned the salvo:

VFW PAC operates as little more than a subsidiary of the Republican Party, as does the leadership of their parent organization. Today, that organization issued a statement toeing the GOP line on the health care vote. Of course, in order to toe that line, the VFW had to make things up.

Now, bear in mind that this is the same VFW that took shots from the right last year for not being offended by the DHS report and backing the President on that one. They also backed an anti-war activists free speech rights, much to the chagrin of many (like me) who felt he was out of line. So, for the VFW, it appears to be a case of “screwed if you do, screwed if you don’t.” I don’t for a millisecond think that the VFW is aligned to any party, any more than The American Legion is. [The VFW does have a PAC however, which operates separately. The American Legion does not, nor ever has had one.] VoteVets however…..well, they’ve yet to meet a Democrat they didn’t like better than his or her Republican challenger. This issue is based on this fight, as seen by both the GOP and DEM staffs of the House Armed Services Committee. First the Majority side, with Ike Skelton saying:

“In the health care bill currently under consideration in Congress, TRICARE and the Non-Appropriated Fund health plans, the programs that provide health care for these individuals, will meet the minimum requirements for individual health insurance coverage, and no TRICARE or NAF health plan beneficiary will be required to purchase additional coverage beyond what they already have. “However, to reassure our military service members and their families and make it perfectly clear that they will not be negatively affected by this legislation, my bill, H.R. 4887, explicitly states in law that these health plans meet the minimum requirements for individual health insurance. “Our brave men and women in uniform provide us with first-class protection, and it is our obligation to provide them—and their families—with first-class health care in return. Every day, our troops risk their lives to stand up for us on the battlefield, and I now ask my colleagues—no matter what your position may be on health care reform itself—to join me in standing up for our service members and their families. “Nobody knows what the fate of the health care bill will be tomorrow, but by supporting H.R. 4887, we will at least know that we have protected those men and women who sacrifice their lives to protect us. “We must affirm for our military service members and their families that even if the health reform bill passes, the coverage provided by TRICARE and the Non-Appropriated Fund health plans will be properly defined in law as meeting the minimum requirements for individual health insurance.”

The GOP side was less certain, but stated essentially the same thing:

“I welcome Chairman Skelton’s concerns, but we—as the leaders of the House Armed Services Committee—have a responsibility to assure our military personnel that their top-notch health care will remain intact before the House votes on final legislation. The Chairman’s efforts are encouraging, but his leadership has decided to vote on a deeply flawed Senate bill,” said Rep. McKeon. “We need to fix this problem immediately—before Congress passes and the President signs the legislation. By forgoing the traditional legislative process, Democrat leaders in Congress—and the President who is pushing for immediate passage of the bill—have reneged on assurances that the Senate legislation would be fixed in a conference committee,” stated McKeon. “Our military personnel deserve to know they will continue to receive the same level of care they so rightly deserve. I look forward to working with the Chairman to include our common language in the annual defense authorization legislation; however, the damage could already be done if the Senate health care legislation becomes law,” concluded McKeon.

So, here is the story. TRICARE and NAF are not certain to be approved under the existing bill about to be signed. Now, why is this? They’ve been working on these bills for in excess of a year, and this is the first we are hearing of it? Well, no, actually, Representative Buyer has been talking about the effects for quite a while, but no one really listened. This is not really to praise Representative Buyer as much as it is to say that no one on the Hill seems to be listening to anyone. Think back on all the important bills that Congress has passed in its days. The Civil Rights Acts, Medicare creation, some of the New Deal Bills. How many of them had one party voting exclusively one way, and the other party splitting its vote and yet the party that voted together lost? I’ve never heard it. Not one Republican broke ranks on this bill, and some Dems, fearful of the vengeance of their constituents voted “No.” What we have here is a failure to communicate. Now, I would take grave exception to the VFW saying that the Democrats, “Betrayed Veterans”….Actually, I think they knew exactly what they were doing, and fully expect them to make the fixes sometime in the next week or two. So, that being the case, why wasn’t this fixed earlier? Well, that takes the discussion in a different direction as well. For those who don’t know how Medicare Reimbursements work, if you are on Medicare, you go to a doctor and for each procedure, the Gov’t will pay a certain amount to that Doctor. That figure is notably less than what the doctor would charge other patients. If the doctor is incredibly busy, he will forego all Medicare patients since he can charge more to those with private insurance. The Congress, in an effort to cut down our ballooning budget has been trying to further cut the rates that the Government pays out at, and this has expected results….Less doctors will take Medicare patients. Now, the cuts are already in as law, but many Members of Congress know that the reimbursement rates are too low, so every year they vote to freeze the drop. And this is part of the “Doctor Fix” that you hear about all the time. But what happened was that President Obama and the Democratic Members of the House are pushing a new mantra of “Fiscal Responsibility” and “Lowering the deficit.” And so, they set an artificial ceiling of 1 Trillion dollars for this bill. One would like to think that this number has some concrete meaning. I mean, why $1 Trillion and not $936 Billion? No reason at all, that was the number they settled on. So what happens next is that the Congressional Budget Office is brought in to referee the situation. The Majority said that they would like, W, X, Y, and Z in the bill, and the CBO said “Well, that would cost you $1.5 Trillion” or so. So Congress sent it back and said, “Fine, drop X and Z.” Bingo, CBO comes back at $900+ Billion, just below the artificial threshold. Now, once that is passed, Congress will go back and say, “But we need the X and Z done now, or our ___[Veterans etc]___ will have an unfair burden.” Everyone will vote for it, because no one wants the veterans to be left out in the cold. And Voila! it passes, without Congress ever having to have added it in the initial bill, and thus keeping the initial bill under the magic number. [As an aside, how good is our referree in this regard? Well, not so good Reason.com tells us: healthcareestimate

This is why the $1 Trillion ceiling is so arbitrary. Not that we should pay less or more, which is up to individual opinions, but rather this is like referring a game while being maced in the eyes.] Here's my analogy: It’s like asking your wife for a vehicle. She says, OK, Fine, buy what you want, but don’t go over 10k. So you run out and buy a Hummer with no engine for $9,567. Now you own a Hummer which either sits in the yard, or goes to work using the Fred Flintstone method. After about a week the wife will concede that a Humvee with no engine is worthless, and tell you to go pay the $2000 to buy an engine. So, did the Hummer cost 10k? Or did it cost 12k? If you answered 10k, you might very well be a politician. [EDITOR’S NOTE: Part Two of this Three part series deals with the first and second order of effects this will have on VA. Please go read that part now. Part Three of this series will address some of the issues that have been brought to light by the commenters in these pieces. So, if you have a question, by all means toss it in there.]

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March 22, 2010 - 2:05pm

Now that the deed ‘tis done, how will it affect you? (Part I)

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