Monday, April 15, 2013

HB 74 vs. last year's HB 392: How has the Kowalko scheme changed?

The first thing you notice about the new Kowalko-Jaques-Baumbach HB 74 calling for single-payer healthcare in Delaware is that they have excised an awful lot of the boiler-plate propagandizing that Dr.  Floyd McDowell put into the original.  There are no more long sermons on the evils of insurance, nor promises to cover every Delaware citizens from "the moment of conception" to death.

This actually now reads pretty much like a piece of legislation, which is why opponents need to take it seriously.

Having said that, I am using the text of the current HB 74 here, and the old HB 392 here to make these comparisons.  Our old work dissecting HB 392 can be accessed here.

On a first read, here are the significant differences:

1.  HB 74 does away with the three County Advisory Boards that previously existed in HB 392, leaving all the power to one centralized state board.

2.  HB 74 eliminates the fraud prevention segment of the old HB 392 without replacing it with anything.  This is significant because--although the fraud section of the old bill was horribly laughable--in HB 392 the law guaranteed, yes guaranteed a 10% reduction in health care costs by initiating this fraud control system.  Having taken out both that system and that promise, we must assume that the new bill is--by the authors' admission--at least 10% more costly than the one they proposed last year.

3.  HB 74 makes a significant revision of the funding mechanism.  Both bills use exactly the same payroll tax as the primary funding mechanism, hitting all employers in the State.  But (and this is significant), in HB 392 the language stated, "This payroll tax may be shared by employers and employees."  HB 74 omits that line, and leaves the total responsibility for paying the payroll to the employer.

There are probably some others that I will find on further perusal, but these stand out.

On the other hand, beginning with simply the most bizarre elements, HB 74 retains the incredible requirement that for citizen consumer groups to participate on the Health Care Advisory Board they must have
have endorsed a single payer health care system at least five years prior to the enactment of this Chapter, to be appointed by the Governor and confirmed by the Senate.
The new HB 74 keeps all of the truly odious elements of the original bill that we have repeatedly dissected here, including the fact that:

The funding mechanism is completely inadequate to pay for the bill, especially since they have eliminated the fraud provision and this bill expands single-payer from Delaware not just to our citizens but to anybody who works full-time for a Delaware employer.  The numbers don't add up, they never added up, and neither Kowalko or Jaques has ever come across with the two studies that they claim justify their accounting.  (Side note:  when we did our analysis of the funding and the guaranteed benefits, we actually overlooked the provision of all dental care as part of this plan.  The case against the solvency of this monster is worse than we thought.)

The provisions that seek to set prices for all health care services totally ignore the fact that there are literally dozens of medical procedures one cannot get performed in Delaware, and brushes by the fact that a very tiny state cannot dictate prices for, say, organ transplants, to hospitals in New Jersey or Pennsylvania.  Nor can you legally supplement any rate the Health Care Authority sets, meaning you are stuck with the quality of care you might receive in Delaware.

How does this play out in reality?  My wife was diagnosed several years ago with needing three-level lumbar fusion.  There are no surgeons currently practicing in Delaware who have ever performed three-level lumbar fusion, and only five with any experience performing two-level fusion.  One of them said he'd love to try it.  Sitting in Philly at Temple is a surgeon who has done three-level fusion over twenty times, and at Johns Hopkins in Baltimore there is a surgeon who has done three-level fusion about fifteen times.  Who would you trust with your back?  Under the new system it won't matter because unless these two world-class surgeons are willing to accept exactly what the Delaware surgeons get (and you can bet it will be much less) as FULL PAYMENT, then guess what?  You are now an experiment for somebody who has never done the procedure.  Comforting?  I thought so.

There's more--there's much more because this bill is still so bad that I am astounded that a normally level-headed (albeit progressive) guy like Paul Baumbach actually associated himself with it.

I also want to check:  is Mitch Crane now for this bill again, like he was for it before he scrubbed his campaign website last year to be against it?

No way that "card-carrying capitalist" Jack Markell lets this stinker become law, but given that Kowalko is a cagey legislator, we have to be careful.


Will said...


§1606. Truly frightening. §1605 only requires a majority of 5 out of a quorum of 8 for the Delaware Health Security Authority Board to make decisions overseeing this character, and he has the authority under §1606 to do just about everything from setting rates to appointing directors of the other Authority divisions responsible for operating this already Orwellian monstrosity.

Anonymous said...

I thought Baumbach knew finance. That's his job, no?