The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Length of Health Care Reform Bills Silliness

Posted by Alan on November 27, 2009

It is both amusing and disappointing to see the silliness that surrounds the serious issue of health care reform.  Examples abound: calls for keeping the government out of Medicare (a government-run health plan, for those keeping score at home); claims that a government-run plan will usher in an era of lower medical premiums buying better coverage; promises of death panels; and the list goes on.

The foolishness that seems to crop up most often are criticizing the bill for being too long. Some opponents of the bill have taken to printing out the 2,074 page Senate Health Care Reform bill (even longer than the House health care reform legislation which came in at 1,990 pages) and lugging it around on their shoulder. Or taping the pages together and rolling the result down the Capitol steps. The theory, apparently, is that health care reform is such a simple problem, it should be easy to accomplish in just a few pages.

I wrote about the importance of looking at what the bill does, rather than how long it takes to do it, in a previous post. But now the Associated Press has actually put things into (numerological) perspective. Here’s what the AP reports concerning the literal size of the health care reform bills being considered by Congress.

  • The House health care reform legislation, HR 3962, is 319,145 words.
  • The Senate health care reform bill, HR 3590, is 318,512
  • The No Child Left Behind Act (supported by many of those criticizing the health care reform bills) was over 280,000 words.
  • English translations of War and Peace, which some critics has claimed is shorter than the Democratic health care reform bills, are 560,000-to-670,000 words.
  • When published in a more normal fashion than formal bills are (single spaced, normal font, regular margins) the bill comes to 209 pages.

Here’s some other meaningless statistics:

The Harry Potter series totaled 1,090,739 words. The longest: Order of the Phoenix at 257,045 words.

The Old Testament has 593,493 words; (No idea which English translation the source used).

How many words would it take to legislate the status quo? Considering the need to create Medicare, Medicaid, Veterans health care, regulate the private market, etc. etc., my guess is we’re talking about reams of paper.

Let’s focus on what matters – what the legislation does – not how many words it takes to do it. There’s plenty of substantive issues to debate. And now’s the time to do it.


32 Responses to “Length of Health Care Reform Bills Silliness”

  1. Roger Millhouse said

    I find it interesting that the government believes they have the authority to mandate anything to each and every American citizen. It is ridiculous and unconstitutional for the government to try and force the american people to buy healthcare. Every single one of the democrats in house and senate needs to be removed from their position. This is not what the american public wants. Government put their hands into the health care before, the result was a broken medicare and medicaid system. I agree insurance companies should not be allowed to deny individuals health care based on pre existing conditions, I also agree they should regulated on how much they can charge people. I think tort reform, and physicians doing pro bono work much like lawyers can do would be a start. Run more free family clinics that are funded at a statewide level by the people for the people would also help. This bill is just being stuffed down our throats regardless of what we as americans think about it. Their days in the House and Senate are limited. This health care bill needs to be repealed.

  2. Schoenherr Creative Services said

    Alan, how do you see “death panels” (i.e., bureaucracy-in-action) as something trivial, dismissive, or “silly?” Will you explain to us how you feel it to be a trifle matter? That, phish-posh, it is just a part of Sarah Palin’s campaign shock-vernacular? A matter so inconsequential we needn’t not worry? Nay, even silly. Yeah, obviously, the wording of such inevitable (in my belief) government review board is Orwellian, and meant to be salacious, but c’mon Alan, you know just such capitation or actuary board will have to exsist on the Fed’s behalf. It’s the Govt. for Criminy sake. Tell us, with a straight face, Government rationing will not ever exsist and summarilly dismiss this notion of dollars v. frugality.

    • Nosedoc said

      Please refer to Alan’s August 13 post “Health Care Reform and the Euthanasia Hoax.” My comment on the matter is #7.

      Is “rationing” of services needed? It depends on the manner in which one decides to define it, but by a broad definition, the answer is a resounding yes. We are hemorrhaging money into diagnostic tests that have no bearing on treatment plan and expensive new treatments that are no more effective than the more traditional ones (prostate cancer treatment options are the best example of this), while our tort system that promotes the over-ordering of diagnostic tests as well as “justifying” excessive self-referral of in-office testing.

      How can we not “ration” Medicare services to some degree? It is commonplace in my practice to see a seventy-something year-old patient with Medicare to find out that both of this patient’s parents are alive (and still on Medicare). We have never had so many individuals alive and over the age of 65 in our country’s history, and with the baby boomers starting to reach retirement age, these numbers are going to swell further. Reasonable controls over the manner in which medicine is practiced with the establishment of evidence-based standards is a must right now. As long as OUTCOMES are not being compromised, then the public is no worse off, and maybe then we can afford universal health coverage.

      • Schoenherr Creative Services said

        Denial of Service v. Containment of Costs are two wholly separate matters. I am never opposed to trimming expenses; but the Hippocratic Oath is a wee bit hard to shun. I still would like to hear Alan’s own response to my original question however.

        • Nosedoc said

          I believe there is a tremendous amount of potential for cost savings before any ethical questions are raised–again, looking for the best outcomes via the most cost-effective manners is the key. The Hippocratic oath doesn’t come into play. The kinds of limitations on care that are present in the British Health System, like denying kidney dialysis for patients over the age of 60 (or whatever the cutoff is right now) regardless of the overall health condition of the patient, would certainly not be acceptable in the United States.

        • Alan said

          Sorry Schoenherr for the delay in responding to your question. I thought it was rhetorical. My apologies.

          The death panel rhetoric Governor Sarah Palin interjected into the debate referred to the idea of having doctors talk to patients about end-of-life alternatives. She mixed into the discussion concern over comparative effectiveness studies that might determine a particular course of treatment is less than worthy of widespread adoption. Referring to these issues as the equivalent of creating death panels is not only nonesense, but harmful to the serious discussion that should occur about how to deal with the skyrocketing cost of medical care.

          Today insurance companies (for private coverage) and governments (for public plans) determine what treatment is covered and which is not. Does that mean we have death panels today? I think not. Does it mean we have rationing? I guess so, if one defines rationing as disallowing people to have whatever medical treatment and services they request. And yet the nation survives and it’s citizens have a health care system roughly half the population prefers to the health care reforms bill circulating in Congress.

          You seem to make the point that its the government involvement in these decisions that is dangerous. I’m not sure it makes a difference whether a government agency or a private company recommends inclusion of a certain course of treatment for inclusion in coverage. It’s still someone making a decision.

          In some instances, the approach taken is to use data concerning the “value” of various treatments as non-binding recommendations on doctors. The doctors can still invoke a more expensive course of treatment, but is required to explain why the less expensive approach wasn’t appropriate. This is an approach that seems to be working.

          Health care reform is a complicated, controvesial issue. To claim that the legislation being considered in Washington will introduce rationing to the American health care system is factually wrong. Politically, it amounts to fear mongering.

          As always, comments from you and others who disagree are welcomed.

        • Schoenherr Creative Services said

          My question, Alan, pertained to your seemingly flip dismissal of “death panels” as being summarily “silly.” Now you state (concede?) that it is indeed a “…complicated, controversial issue.” My hair-splitting and rabble-rousing position is that too many of us sheep progressively try to accept the idea of government-run healthcare as a panacea we will all somehow trust and benefit from in Shangri-La. Actually, my real sophomoric point is an erstwhile attempt to raise awareness of every single element to this debacle as shear lunacy; and that far too many Americans are willing to forgo their ability to exercise common logic and sense in favor or fear of the Khrushchev-style shoe hammering from Washington.

          I remember as a young naive schoolboy the indignation of seeing insurance CEOs at healthcare summits being physically accosted as if they, somehow, were the enemy in this war and nobody on our side willing to truly bare knuckles and knock heads to stop these attacks once and for all. Greed or ineptitude was never the real reason for the industry’s faults, but it became the rallying cry for the reformers. And these same people, the neophytes, as it were, used this as their weapon and nobody cared to face them because we all knew their notion was “silly” and not worth the bothersome effort. It’s just their “spin” on it we all said convincingly to one another. It (healthcare “reform”) has now festered and manifested in to what it is today, built upon momentum, mostly due to politics and never out of real necessity, (look at the polls!) and yet we sit here now on the precipice of no return. For what? Because nobody was dissecting the enemy word-upon-word and only idea-by-idea for fear of being labeled politically incorrect or worse. My point? We all blew it and have nothing but ourselves to blame. I for one, am tired of turning the other cheek willing to lose a battle in an effort to somehow win the war. Frankly, I found it doesn’t work.

  3. Nosedoc said

    Objective and worth reading:

  4. Groo said

    Take a look at these few posts about Healthcare Reform.

  5. Devbeth said

    The really sad thing about all of this is that the government could change the eligibility for the plan offered to federal employees and allow the general populace to enroll in it. While it would not have been simple, it would have 1) been easier than what we have witnessed these past few months;2) saved untold dollars, and 3) much teeth gnashing.

    • JimK said

      The attached link is to the Blue Cross rates for NY State under the Federal Employees Health benefits program. The family rates range between 12K and 14K annually, therefore unless you are proposing that the government provides the same subsidy for all enrollees the plans are expensive and if you are proposing the government subsidize all enrollees then where is the dollars savings.

      • Nosedoc said

        $12-14K would be a bargain for a family of 4 in New Jersey through a small business for a reasonably generous BC/BS PPO compared to what is being paid now, probably 180% or so of that, depending on the prescription and office co-pays.

        • JimK said

          The premium increase for next year is approximately 15% and while I am sure it is still a bargain for many families, if the federal plan becomes the insurer of last resort how long do you think these plans will retain those bargain rates.

        • Nosedoc said

          Not long, especially if cost containment is not seriously addressed as part of the overall reform plan.

  6. James S. Thornton said

    As always, Allen, just another brilliant explication of yet another fascinating tidbit in the ongoing saga over American health care torturous odyssey towards reform.

    What makes the big picture so fascinating is how the multiple artists involved in the whole business tweak every single potential advantage to rally support for their point of view.

    To me, the most interesting bullet point regarding the length of the two bills, which pretty much every one alive has been conditioned to believe are absurdly long, was this one:

    * When published in a more normal fashion than formal bills are (single spaced, normal font, regular margins) the bill comes to 209 pages.

    To be sure, I don’t know whether most people would still care to read 208 pages of standard book-style text. But at least this is doable, unlike the + or – 2,000 pages in the bills’ original forms.

    Thanks, Allen, for holding accountable the demagogues on all sides of the debate even if, judging by some of the comments here, not everyone seems capable of understanding the point.

  7. The Associated Press must have been having a slow day of things to sensationalize. Shame one them. I thought they were suppose to report news. AS if anyone in there organization remembers what that was.

    • James S. Thornton said

      I am not sure what you mean by this. Putting the much hyped and ballyhooed “prohibitive length” of the health care bills into perspective seems to me not only a legitimate and newsworthy enterprise for reporters to undertake, but a public service as well.

      And what is your beef with the Associated Press? Is this just a knee jerk criticism of journalism at large?

      At the risk of seeming petty, your broad brush criticism of the work of the many journalists working for the AP would be a little less obnoxious if you would consult the AP Style Book before posting your replies. This would tell you that the word “there” is misspelled in your sentence, “AS if anyone in there organization remembers what that was.”

  8. mark said

    They say they will pay for it by reducing fraud in medicare.
    I say first show us that you are capable of that and then we will speak.

    • James S. Thornton said

      Again, it seems disingenuous to me that the anti-reform backers seem to hate litigators so much at the same time they rail against fraud and waste in the Medicare system. Much of the waste and fraud that does come to light does so, in part, by attorneys who work with whistleblowers within various health care settings to expose abuses and fraud.

      I am not sure if this still exists, but there used to be a fairly hefty bounty available for those who reported and documented fraud. Granted, this can look like attorneys trolling for rat finks willing to testify against their bosses, but if it’s the only way to find out these schemes, I say more power to them.

      You can’t have it both ways. If there are crooks inside the health care system, you need lawyers to ferret them out.

  9. 2 PREDICTIONS: The Senior population will revolt over the GUTTING OF MEDICARE ADVANTAGE.The MEDICARE ADVANTAGE clientele is used to paying little or nothing and will boot the Democrats out of office if the Dems reduce the subsidy..They cant afford MED SUPPS AND PART D,especially as they move into their mid 70s as the premiums are age banded for MED SUPPS.In Orange county,california,it is not uncommon to have a 75 year old paying $450 per month for a Classic F Med supp,Part D and dont forget Part B(Min $96.40 mo). The second SILLINESS is this CROSSING STATE LINES WITH health plans. THE rATES ARE BASED ON LOCAL COSTS AND CONTRACTS WITH LOCAL MEDICAL GROUPS AND HOSPITALS.I can just see an insured walking into an ORANGE COUNTY DOC OR HOSPITAL WITH HIS LOW COST PPO FROM MISSISSIPPI.He wil get an OUT OF NETWORK BILL that will choke a horse.!! Where do politicians come up with such stupid ideas!!!!Reduce costs by good prevention programs,MEANINGFUL TORT REFORM and prohibit ridiculous testing runups at the end of life(see 60 minutes last week)CONGRESS GIVE MEDICARE ENOUGH OF A BUDGET FOR FRAUD ENFORCEMENT.. LAST THING..LET THE VA NEGOTIATE DRUG PRICES FOR MEDICARE/MEDICAID.. They do a good job for the VA,WHY NOT FOR MEDICARE..

  10. raymond said

    If a reporter is reading this blog i want you to ask the President the following question:
    Mr. President If every single person in this Country asks that you do not sign this bill will you still sign it?
    He might say yes but if he doesn’t ask him what % of the country has to be against it in order for you not to sign it

    Dont let him give some looney political answer like uh uh uh We are uh uh going to cut COSTS uh uh uh We are going to uh uh increase competition. If he tries pulling one of those on you say sorry you are not answering my question. This is YES OR NO .
    Are we a government by the people for the people.

    • James S. Thornton said

      For what it’s worth, I know not everyone in the country would ask the President not to sign the health care bill. I know this because I, for one, would plead with him to sign it.

      And I suspect the majority of people feel that whatever bill does reach his desk is almost certainly better than what we have now.

  11. cleveland man said

    AT the end of the day this bill is being stuffed down our throats. I wish we could have a system were everyone gets free insurance- I wish there was a system where everyone gets free Lamborghini’s also. It is just not possible and I certainly will not trust a government who spent 24k for each cash for clunker car

  12. Dave Wood said

    Using the word silliness when talking about a life and death issue like health care is itself, “silly”.

    Democrats use language that is purely political like, “I am for high quality, affordable health care for all” which was stated by Democrats all year long. The reality is Obama care will not be more affordable to us current payers at all. It will only make affordability within reach of the current uninsured. As for high quality, depends on which hospital you end up in. And as for the health care for all, aint gonna happen. Obamacare will still leave around twenty million uninsured, if all that is promised actually happens.

    Republicans have lots of crap spoken as well like, “this government take over of health care” Nonsense, Obamacare only pays for private insurance in a competitive marketplace.

    Dont be surprised if this time next year we are fixing Obamacare. Assuming Republicans take back the house, they will surely slow down Obamacare to give some red meat to their presidential candidates in 2011. The presidential race in 2012 will surely have Obamacare on the agenda. Republicans will seek to slow it or even kill it while Obama will defend it.

  13. jimmy1920 said

    You can take you old clunker to the repair man and say “fix it because I just love it”. Do you complain about the 10 page repair bill? The choice was always there to get the one page invoice for a new car (HR676).

    Simple was taken off the table before we ever started.

  14. Nosedoc said

    Perhaps the peak of silliness surrounding the health care reform legislation is the lack of that immigration reform to precede it. We can be certain that millions of undocumented aliens will be left to seek their medical care from our hospital emergency rooms with the costs being shifted to the paying patients and their insurers.

    • jimmy1920 said

      Your point?

      A couple of months ago I was bicycling along the W&OD trail and I passed a woman prostrate along side the trail, suffering from what appeared to me was heat exhaustion. I offered her water from my water bottle until she was able to stand and walk around.

      The woman was dark skinned and spoke English with an accent. It occurred to me that if I had the mind set of some of the anti-immigrant health care people, I should have asked for her green card or passport before extending her a helping hand.

      • Nosedoc said

        My point is that the health care reform will fail to address the care of undocumented aliens, leaving unchanged a huge percentage of the total uninsured in the U.S., with the hospitals and providers left with huge financial and medico-legal liabilities. I believe it is ludicrous to not define which immigrants should stay, contribute to our society and reap the benefits of being legal members of out society. Our current immigration policies serve neither our legal citizens nor those who aspire to achieve legal status adequately. It is not my intent to imply any judgments on who who should be allowed to stay, receive care, etc. and who should not.

        That said, the days of individuals flying in from abroad to get into a cab at the airport to proceed directly to an American emergency room for care they could not receive for free in their home countries need to come to an end. The U.S. simply cannot afford this very prevalent phenomenon.

        • James S. Thornton said

          That said, the days of individuals flying in from abroad to get into a cab at the airport to proceed directly to an American emergency room for care they could not receive for free in their home countries need to come to an end. The U.S. simply cannot afford this very prevalent phenomenon.

          This is one of the more laughable items of propaganda I’ve read in months. Who are you, Nosedoc? Lou Dobbs?

          Can you provide one example of this “very prevalent phenomenon” actually occurring post 9/11 that is not an urban legend? Do you have any idea how impossible it is for citizens in less than favored countries to even get a travel visa to the US these days? A Swiss au pair from a rich family in Zurich can get in, but an Indian from Ecuador?

          Forget about it.

          Absurd racist propaganda of the most xenophobic variety.

          So what do you recommend be done with the millions of illegal aliens already in the country? The cost to have the military round these people up and deport them would make the current bailouts look like chump change.

          In the few towns in PA where anti-immigrant bias has been instigated by the Dobbsian types, the economic downturn of the affected municipalities has been devastating. Did it ever occur to you when you’re munching on fresh fruits and vegetables how much more expensive these would be without a willing and underpaid workforce to pick your food in the fields.

          You should be grateful, not condemnatory, my good man!

        • Nosedoc said

          I am a physician and surgeon who trained and still works in the New York-metro area. I willingly continue to take care of numerous indigent patients every week, and provide a substantial amount of free service at the hospital with which I am affiliated. What I stated above is not propaganda, nor does it reflect xenophobia. Travel to the U.S. for free medical care is a reality, and has been occurring for years at virtually every urban hospital in the U.S. (among many others). Our hospitals are duty-bound to provide the care through EMTALA. Oh, and I don’t watch Lou Dobbs or Fox News for that matter. I just keep my eyes and ears open as I do my job, and I see the inequities in the health system all around me. One of them happens to be that people come to the U.S., receive high quality and often life-saving health care from our providers then go back to their home countries, leaving our citizens to eat the bills. I can’t give examples as this violates our federal confidentiality laws (HIPAA).

          As for immigration policy, if you read what I wrote above carefully, I merely stated that policies need to be established to eliminate the huge numbers of undocumented aliens in the U.S., and I neither stated or implied how I would achieve this end. I made no value judgments whatsoever. Undocumented aliens generally do not seek preventive care or early outpatient interventions for their ailments, but rather tend to show up at our emergency rooms with more advanced disease, requiring more expensive treatments. This represents a huge cost to our hospitals which then gets passed on to the taxpayers and individuals with private insurance.

          Mr. Thornton, you are clearly a man of strong conviction, with passionate feelings on a number of social issues. That said, I suggest that you avoid making any more assumptions of malicious intent before judging those who post comments on this or any other public blog. You don’t know me or any other participants in these discussions, so it just comes off as a little crazy to go off on rants like the one above.

        • jimmy1920 said

          Well Doc, Kudos to you.

          First, my comment above was not directed at you personally, and I hope you did not take it that way. I think the immigration issue is a distraction. For far too many people, the possibility that a single undeserving immigrant should benefit from government largess is reason to discard reform for 40 million deserving Americans who need health care, most of them in the work force or trying to get into the workforce.

          We should fix immigration, but not at the expense of health care for deserving Americans. Perhaps, we should bill the governments of those “free loading” immigrants. After all most of the countries they come have government sponsored health care.

          But I was more impressed with your willingness to treat those with out health insurance. My experience would indicate that you are rare exception in your profession. I administer a $120 million employer sponsored benefit program. Every single day we get calls from members who were denied treatment by physicians, almost always because of some bureaucratic snafu. There was the member’s daughter who was prepped for surgery to remove a tumor and was sent home in her hospital gown when they discovered she had no insurance.

          One of my “favorites” was a woman who was denied treatment because when the doctor called the insurance company they were told that the person standing in front of them with the same name, the same birth date, and the same sex, and the same SSN was a child and not a spouse. The office could clearly see that this was no child. She was denied treatment. This same error repeated itself over several months and took several months to correct permanently (don’t ask me why, it wasn’t our error). And each time the patient was denied treatment. Maybe you could overlook the first occurrence, but??

          I could go on and on and on.

          Now I certainly don’t mean to fault doctors for a system that is far too bureaucratic. But I regard with a great deal of skepticism any claim that doctors treat any patients without a guarantee of payment.

        • Nosedoc said

          No offense taken. I perceived was that your comment was a cue for me to explain my prior comment.

          I agree with you that affordable, broadly accessible and fair health coverage is a priority right now. As a physician with 20-plus years left in his career, I view the financial sustainability of the health reforms as an equally important goal, i.e., it doesn’t matter how high a percentage of Americans have health coverage in 2013 if the system is going to implode under its own weight in 2017. I, therefore, see it as essential for all people who are in the U.S. receiving health care to be accounted for in the cost projections from the outset.

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