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James (@willia4)
James is going to have to read the 1000 page House bill just so he can honestly say "Yes, actually, I *have* read the health care bill and there aren't any death panels in it. So please stop making things up."
August 11, 2009
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Heather Solos, DGentry, Zulema ⋅ spicy cocoa tart and 16 other people liked this
[Crossposted from Facebook]: Fortunately, it's a thousand double-spaced pages. ;) Apparantly, Congressmen use the same tricks that eighth-graders do...
- James (@willia4)
[Crossposted from Facebook]: The last time I read a bill was the Patriot Act. I'd forgotten just how awful these things are. Supreme Court opinions, in contrast, are usually easy-to-read and often entertaining. I guess that's what comes from not facing elections. You can say things in English.
- James (@willia4)
[Crossposted from Facebook]: So far, my favorite part is on page 39 where they define "Plain Language" for all the lawyers.
- James (@willia4)
The bill would establish an ombudsman who would perform his/her duties "in a linguistically appropriate manner". I don't know exactly what that means, but I'm going to start telling people that I do my own job in a linguistically appropriate manner. (I assume it means the ombudsman's office would work with people in both Spanish and English)
- James (@willia4)
It's kind of interesting how similar a bill is to a piece of software. There are subroutines where the bill constantly refers to other parts of itself in a "section XXYYZZ also applies in this situation." There are library calls where the bill refers to sections of existing laws in the same manner. A bill patches existing law by inserting and removing words and sentences.
- James (@willia4)
It even has an exception handler where it says "Even if part of this bill is unconstitutional, the rest of it stands." That's the legal equivalent of ON ERROR CONTINUE.
- James (@willia4)
All of this makes it harder to read. Since the US Code lacks a "Jump to Definition" shortcut, the PDF should at least have hyperlinks to the referenced material.
- James (@willia4)
Going back to Legislation-As-Programming, I'd rather read Perl.
- James (@willia4)
The first 100 pages of the bill are mostly preliminary. It doesn't start getting interesting until page 98.
- James (@willia4)
There's a lot of "there is hereby appropriated, out of any funds in the Treasury not otherwise appropriated, [insert huge sum here]". This implies that the Treasury has a ton of money just lying around. Every time I start to learn how the government actually works, it makes my head hurt.
- James (@willia4)
In case you're curious, "NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS" is on page 143. It's in bold and rather difficult to miss. So I dunno why people keep claiming the bill says otherwise.
- James (@willia4)
Page 149 of the draft copy I'm reading ( http://docs.house.gov/edlabor... ) says "IN GENERAK". I'm assuming it's a typo for "IN GENERAL", but it could also be implying that employer contributions are to be turned over to the evil alien overlord, IN GENERAK. Yet, somehow, we never hear about this from the Right. Are they in bed with the aliens?
- James (@willia4)
I'm 15% through the bill (page 152) and so far I haven't found anything terribly threatening to the Republic. I'll have to finish it later just to be sure; sadly I can't read any more right.
- James (@willia4)
Page 171: if your religion says "socialized medicine" is evil (or any health insurance at all is evil -- I've known some people like this), it's cool. You can get an exemption.
- James (@willia4)
Page 172-173: Are you on Medicaid and are happy? It's cool. Keep doing what you're doing. Same with Medicare. Same if you're in the army or have VA care. If it works for you, keep it.
- James (@willia4)
Page 171: Do you have insurance? Happy with it? It's cool. Keep doing what you're doing.
- James (@willia4)
If you make a ton of money, your extra taxes to pay for this are on pages 197 and 198. I don't think it's particularly onerous, but I don't make anywhere close to $350k, so what do I know? [Edit: it's $350k if you file jointly. $175k if you're married and file separately. $280k if you are single. I still don't think it's particularly onerous.]
- James (@willia4)
Page 199: If the government's cost-cutting efforts exceed our wildest expectations, rich people don't have to contribute any more than anyone else. [Edit: I don't expect this provision to go into effect. So the wealthy are still on the hook.]
- James (@willia4)
Sec 442 on page 204 is the first fishy part of the bill; but since it's just changing a date in an existing law that I don't feel like looking right now, I don't know what it actually does. Still, it could warrant further investigation.
- James (@willia4)
I'll be honest: I'm skimming the bits that are just modifying all the various tax laws to account for the new health care taxes. They're just a little too lawyery for me to take.
- James (@willia4)
Not a good sign: page 216 is a brand new table of contents. I'll assume this is standard practice for legislation, but it's still a bit unnerving.
- James (@willia4)
Page 216 is actually starting a whole mess of revisions to existing Medicare laws. So it's mostly just "strike this" and "add that". So I really have no idea what it's doing. It seems fine, though. If anyone wanted to dredge up the actual changes it'd be making to actual statutes, I'd be interested in reading that.
- James (@willia4)
So yeah. I have no idea what this title is actually doing. I'm pretty sure it's not creating death panels though. Every non-trivial bill that I've ever looked is like this, though, so I don't think it's some scheme by the President to pull one over on is. I think we just have a system that doesn't value transparency.
- James (@willia4)
Which makes saying "I believe in transparency" a great way to get votes. One way that law is very different from code: we have all these patches, but we have no build process and we have no tests and we have no debugger.
- Jason Wehmhoener
Obviously, we need to switch our legal system over to git or hg. Then instead of bills which insert or remove things from existing laws, Congress could just pass around changesets. diff for the legal system? Bring it.
- James (@willia4)
The bill does require that all [most?] the Medicare changes be made in a budget-neutral fashion. Of course, "budget-neutral" is often talked about but I've never really noticed it in practice.
- James (@willia4)
Page 278: if Medicare is paying for oxygen for you and your oxygen supplier goes out of business, you're allowed to buy oxygen from someone else. Surely, no one has any complaints about that!
- James (@willia4)
I like page 414: if someone speaks in Spanish to you to explain Medicare, you can't be charged a copay for the privilege.
- James (@willia4)
Ah! The infamous page 425! Medicare will pay for a physician to "suggest people to talk to"! *gasp*
- James (@willia4)
There is absolutely nothing on page 425-430 that should be controversial. Unless, I suppose, you think my grandmother should be forced to be alone, in pain, and terrified when she finally dies. Which is basically what teabaggers are arguing for with their opposition to that bit of the bill. Bastards.
- James (@willia4)
Now that I've actually read the relevant legislation, the whole death panel thing makes me *incredibly* angry. It's not just the blatant lies. It's the fact that these people are so wedded to their ignorance that the mere thought of my grandmother making an informed decision about her own life is awful to them. To protect their own bubble of idiocy, they want to take all the power they can away from her. She's just a little old lady. She doesn't need those kinds of enemies.
- James (@willia4)
Page 440 brings us the unfortunate title "COSTS OF AIDS".
- James (@willia4)
Page 443 starts talking about incentives to care providers to drive down medical costs. It goes on for some time. I don't know if it will be effective or not; but at least they're trying.
- James (@willia4)
The tests of various incentive and measuring programs will begin no later than 2012. Reports will be made to Congress on the results of the various trials.
- James (@willia4)
I think page 489-493 makes Medicare cover marriage counseling. That should probably not be in this bill.
- James (@willia4)
Page 501 is where the bill establishes a center for comparative effectiveness research, which is something you might have heard about on the news.
- James (@willia4)
I did not see any requirements that the results of the comparative effectiveness research must or should be used to determine payouts. But I could've missed it (or it could be later). If you know where that is, please let me know.
- James (@willia4)
I forgot to note that I'm now halfway through the bill.
- James (@willia4)
Page 525 starts a pretty big chunk of text devoted to making nursing homes suck less. I can't tell if it will be effective or not. I'm also not sure that this belongs in this particular bill; but it certainly belongs here more than the marriage counselor provision.
- James (@willia4)
Page 578 defines "Good Faith".
- James (@willia4)
The nursing home stuff goes on through page 620. Page 621 starts talking about measuring healthcare quality and the government setting priorities based on those measurements.
- James (@willia4)
Page 635 is titled "Physician Payments Sunshine Provision" which sounds much cheerier than the actual text.
- James (@willia4)
I have no idea what the "Physician Payments Sunshine Provision" actually does. My brain simply cannot process those words.
- James (@willia4)
Page 697 provides harsh penalties for people not eligible for government health benefits who try to game the system and get them anyway. [Edit: actually, it might be penalties for doctors who try to game the system as opposed to uninsured patients. It's hard to tell without reading other laws. Which I don't have the time or inclination for.]
- James (@willia4)
I mention page 697 (and page 143) because a lot of critics seem terrified that "teh Mexicans!!!" are going to go to the doctor on America's dime. The bill is pretty explicit in dealing with that. I can only assume that these particular critics are lying for some reason.
- James (@willia4)
Oddly, no one seems concerned that Canadians are going to sneak across the border to get free American healthcare. Which is strange considering how bad they tell us Canada's healthcare system is.
- James (@willia4)
Page 701-704 also deals with ineligible people.
- James (@willia4)
Page 722 requires a doctor to actually meet a patient before sending expensive equipment to their house on the government's dime. I'm amazed that this wasn't already a requirement.
- James (@willia4)
Page 726 - If you're a doctor and you get more money from the government than you're supposed to, you have to send it back. I can see why doctors might be against that...
- James (@willia4)
I'm stopping at 733 for now. Blame Microsoft.
- James (@willia4)
You know how the President has talked about removing waste from the current system to reduce costs? That starts on page 735. Like Page 736 which starts the "Hey, guys! Why do we have two databases with similar (and often duplicate) information? I bet we could make do with just one."
- James (@willia4)
Page 741: Family of 4 and make less than $29400 a year? Welcome to Medicaid. Single and make less than $14440 a year? Welcome to Medicaid.
- James (@willia4)
I *think* page 775 starts removing restrictions on who is eligible for Medicaid. But it's a little too legal for my untrained brain to interpret.
- James (@willia4)
I'm surprised I haven't heard much about page 770 which has "Sec. 1714. State Eligibility Option for Family Planning Services". I've read this (through page 778) a few times now and I still don't know what's actually covered and who's eligible for it.
- James (@willia4)
Even though it's sprinkled through the bill, I still don't know what a "medical loss ratio" is. That's probably important.
- James (@willia4)
The Washington Post says the medical loss ratio is "...the fraction of revenue from a plan's premiums that goes to pay for medical services." (http://www.washingtonpost.com/wp-dyn...)
- James (@willia4)
A [partial?] list of programs encountered so far: private health insurance providers with multiple plans, a public health insurance provider with multiple plans, a federal health insurance exchange, state-level health insurance exchanges, Medicare, Medicaid, CHIP. I've probably missed some.
- James (@willia4)
Page 813 starts talking about Puerto Rico. I'm just going to skip this bit entirely.
- James (@willia4)
Page 833 defines "The United States". Really.
- James (@willia4)
Page 859 establishes the Public Health Investment Fund with $88.7 billion over 10 years with $4.6 billion for 2010.
- James (@willia4)
Among other things, that $88.7b will be going to public health clinic, student loans for doctors, nurse training programs, and programs for researching public health quality (pages 862-863)
- James (@willia4)
Page 863 has a disturbing note about the $88.7b: Washington doesn't have to count it when balancing the budget.
- James (@willia4)
Page 865 starts going into more detail about paying for doctors' education: they'll have to work for it. They can work in public clinics or teach.
- James (@willia4)
A lot of pages (and a big chunk of that $88.7b) is being spent on training health care providers to keep up with current practices and to get better at practicing preventive medicine. As advertised.
- James (@willia4)
The bill sets of up a lot of advisory committees, almost all (if not all) are unpaid. What's in it for the committee members? The prestige? The ability to steer policy in a way that's good for them and their businesses?
- James (@willia4)
Page 937 sets up a task force. "Task force" is a cool sounding entity. I'd serve on a task force just because of the name. (It's at this point in the bill that I start getting a bit loopy, it seems...)
- James (@willia4)
You go James!
- Ruchira S. Datta
Page 951 specifically points out that it will only provide evidence-based preventative medicine. Three cheers for science!
- James (@willia4)
Page 952 coins the phrase "Health Empowerment Zone" and immediately loses whatever points it scored with evidence-based medicine.
- James (@willia4)
Page 971: the top priority in formulating our national health care strategy regarding quality will be to reduce infections caused by health care. I approve.
- James (@willia4)
Page 993: Provide money for school-based health clinics. At this point, I'd say they're overreaching.
- James (@willia4)
And done. I'm sure I skimmed at least 70% of it and it still took me two days to get through. Remind me not to go to law school.
- James (@willia4)
I will attempt to write up a more coherent opinion on this bill, American health care, and legislation in general. I expect that to take some time, though. Hopefully I'll have it finished by next week. Until then, thanks for following along!
- James (@willia4)
well done!
- Imabug
Congratulations, and thanks!
- Ruchira S. Datta
That was epic. Thank you for doing this!
- Victor Ganata
Now that you're prepared, I'd like you to patrol Twitter (#tcot) and Facebook to call bullshit on the right wing spin meisters and parrot people that just repeat whatever they hear on their fave cable news channel. Thx.
- Paul Reynolds
You are awesome.
- Bran Mydwynter
I somehow failed to note it originally, but the bit forbidding discrimination based on pre-existing conditions is on page 19. The bit where you get to keep the insurance you have now is on page 16. These are early enough that if you were reading the entire bill, your eyes would not have started to glaze over just yet.
- James (@willia4)
Fascinating! Great work, James!
- Stephen Mack
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