Freedom First Society

Issue:  H. R. 2 Medicare Access and CHIP Reauthorization Act of 2015. A bill to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children’s Health Insurance Program, and for other purposes.

Result:  Passed in House, 392 to 37, 4 not voting. Became Public Law 114-10 (signed by the President 4-16-15). GOP and Democrats scored.

Freedom First Society: The passage of H.R. 2, with overwhelming support in both parties, was heralded in the media as a great example of bipartisanship. When political adversaries agree, there shouldn’t be anything to worry about, right? Wrong!

H.R. 2 was built on the unconstitutional socialist assumption that the federal government should control America’s “health care system” — managing doctors and controlling the health care Americans can receive. The Congressional Budget Office estimated that H.R. 2 would add $141 billion to the federal deficit over the next 10 years.

We have assigned (good vote) to the Nays and (bad vote) to the Yeas. (P = voted present; ? = not voting; blank = not listed on roll call.)

Bill Summary: H. R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, is a complex measure (the engrossed bill ran to 95 pages that referred to many other pages of existing law).The following excerpts taken from the greatly simplified Congressional Research Summary (CRS) of the measure, as introduced, provide a foundation for the analysis that follows: (although H.R. 2 was not amended in either the House or Senate, later CRS summaries were greatly expanded):

“Directs the Secretary of Health and Human Services to establish a Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) shall receive annual payment increases or decreases based on their performance….

“Requires the Secretary to: (1) draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals….

“Declares it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records technology nationwide by December 31, 2018….

“Amends SSAct title V (Maternal and Child Health Services) to extend: (1) abstinence education; (2) personal responsibility education program; (3) family-to-family health information centers; and (4) maternal, infant, and early childhood home visiting programs.

“Amends SSAct title XXI (State Children’s Health Insurance Program) (CHIP) to extend the CHIP program through FY2017….

“Extends through FY2015 the Secure Rural Schools and Community Self-Determination Act of 2000.”

The Congressional Budget Office (CBO) analyzed the financial impact of H.R. 2. From the CBO summary:

“Over the 2015–2025 period, CBO estimates, enacting H.R. 2 would increase both direct spending (by about $145 billion) and revenues (by about $4 billion), resulting in a $141 billion increase in federal budget deficits (see table on page 2). Although the legislation would affect direct spending and revenues, it would waive the pay-as-you-go procedures that otherwise apply.”

Analysis: The passage of H.R. 2, with overwhelming support in both parties, was heralded in the media as a great example of bipartisanship. Americans are supposed to be reassured, because both parties found common ground.   When political adversaries agree, there shouldn’t be anything to worry about, right? Wrong!

Bipartisanship Today

Bipartisanship on significant matters today generally means that the leaders of the two parties have combined to slip a subversive socialist power grab over on the American people under false colors. It also means that the leadership figures the deception is strong enough so that the people won’t catch on.

In her endorsement of H.R. 2 on the House floor, House Minority Leader Nancy Pelosi argued:

“This package includes many important victories for low-income seniors, children, and families. There are many reasons to support this bill, four of which I would like to point out:

“We are strengthening the quality of care for many older Americans with additional funding for initiatives that help low-income seniors pay their Medicare part B premiums.

“We have added almost $750 million for training more urgently needed nurses and physicians.

“We have secured the health care of poor children with a 2-year extension of the Children’s Health Insurance Program at the same rates set by the Affordable Care Act….

“Lastly, we have secured critical funding for community health centers over the next 2 years, expanding a vital investment in underserved communities.

“I am proud to rise in support of this historic, bipartisan package. It represents bold, necessary progress for our country. And it is not just about enabling our seniors to see their doctors, which was the original purpose of the bill. It is about how we can increase performance and lower cost; it is about value, not volume of service; it is about quality, not quantity of procedures; and this legislation is transformative in how it rewards the value, not the volume. So I am proud to support it….

“It was my privilege to work with the Speaker in a bipartisan way on this legislation. I hope it will be a model of things to come.”

In turn, House Speaker John Boehner praised Pelosi for “her indispensable leadership in helping tackle these challenging issues.”

Any federal involvement in the health care business is flatly unconstitutional and for good reason. America did not become a beacon of hope to the world because of paternalistic government, but because government got out of the way and let the people produce and keep the fruits of their labors.

The debate over health care further illustrates that even the most “conservative” politicians regularly deceive the American public by keeping the debate focused on symptoms, while ignoring the revolutionary socialist agenda driving the nationalization of healthcare. Conservative opponents of the liberal/socialist agenda regularly debate the false pretext of humanitarianism advanced by proponents of the government take over.

In so doing, they ignore the real driver of the power grab — elites who see federal control of health care as a route for controlling people by making them dependent on the federal government for essential services.   Ignoring this deceptive socialist strategy in order to make socialism more efficient does not help America return to a path to greater prosperity and freedom.

H.R. 2 is actually another significant step forward on the path to complete nationalization of health care.  In 1965, following extensive lobbying by radical union boss Walter Reuther and the (Fabian Socialist) Americans for Democratic Action, President Johnson was finally able to overcome decades of constitutional objections and public opposition to this power grab and saddle America with Medicare and Medicaid.

President Johnson was only able to do so by playing on emotion following the assassination of President Kennedy and arguing that this is what the young president has wanted. The American health care system does need reform — the real reform of getting the federal government out of the system.

The “Doc-fix” Pretext

Healthcare costs skyrocketed as soon as the Medicare bureaucracy was established. Huge paperwork expense became associated with even the simplest of treatments. And federal intrusion further entrenched the third-party payer system, which undermines natural cost control.

In his outstanding 1993 exposé Code Blue: Health Care in Crisis, Dr. Edward Annis, past president of the American Medical Association and a leader in blocking the federal takeover for many years, described the reason health care costs skyrocketed:

“All of the current problems in the medical marketplace — hyperinflation, millions of uninsured Americans, excessive administrative costs — carry a “MADE IN WASHINGTON” label. Yet the truth remains hidden to most Americans….

“Finagle all they will, bureaucrats and entrepreneurs will never overcome the problem of excessive cost without correcting the basic flaw: the system of third-party payers, whether government or corporate. There is no more efficient or effective method of delivering health care than the private doctor serving the patient who pays directly for the service provided.”

In 1997, Congress passed the Balanced Budget Act. Part of that plan revised the formula for reimbursing physicians who treated Medicare patients with something called the Sustainable Growth Rate (SGR) System. Essentially Congress was trying to control rising costs by blaming doctors. Naturally, many doctors threatened to quit treating Medicare patients. Congress has responded to its created “crisis” 17 times by delaying the SGR temporarily — the so-called “doc fix.”

Merit-based Incentive Payment (MIPS) system

The new system to be phased in following the enactment of H.R. 2 is being heralded by Republicans, Democrats, and especially President Obama, as a permanent “doc fix.”

However, the pretext of fixing a flawed plan for reimbursement of doctors obscures a further advance in federal control. In reality, the new law provides the Medicare bureaucracy with great new financial power over health care providers by tying reimbursement level to performance in implementing its wishes. Instead of being accountable to patients, health care providers must increasingly view the feds as their bosses.

And concurrently, the enormous Medicare cost burden on society is merely shifted where it is less visible.

Look at the Text!

Although everyone knows that the federal bureaucracy is huge, that fact really doesn’t come home until one looks at the enormous scope and variety of the federal undertaking today.

We urge readers to peruse the text of H.R 2 and see for themselves the complexity of federal regulation. We think many will be astonished at what our lawmakers attempt to understand and what the billing department of a doctor’s office must be trained to understand.

Keep in mind there are many hundreds of similar unconstitutional programs and overreaches in the federal budget.   Overseeing such a monster responsibly exceeds the ability of Congress, even when subdivided into a dozen appropriations subcommittees.

The solution: a much better informed electorate must force Congress to cut back the federal government to constitutionally authorized limits.

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