More Health Care Details

Everytime I think that I have just about squeezed everything I can from the Democrats' health care bill, I find a few more things to mull over.

One thing that is clear from the fine print of this bill is that the Democratic plan looks to find ways to pare down the amount of money that you spend on deductibles, coinsurance and other portions of your health costs.

As we discussed yesterday, there is one provision in the bill that waives deductibles for all colorectal screening procedures.

On p. 486, there is a provision that eliminates coinsurance payments (in outpatient hospital settings) for sigmoidoscopies and colonoscopies.

Section 1721 of the bill on page 778 talks about "Payments to Primary Care Practitioners," and how in 2010, payments would cover 80% of the cost, 90% in 2011 and 100% in 2012.

In a section where a big list of newly covered preventive services under Medicare are spelled out, it also says that those services won't be taking more money out of your pocketbook.

"With respect to Medicare covered preventive services, in any case in which the payment rate otherwise provided under this part is computed as a percent of less than 100 percent of an actual charge, fee schedule rate, or other rate, such percentage shall be increased to 100 percent," it says on page 494.

The expanded list of preventive services that would now be covered in Medicare deserves attention as well.  It includes:

* Prostate cancer screening tests
* Colorectal cancer screening tests
* Diabetes outpatient self-management training services
* Screening for glaucoma for certain individuals
* Medical nutrition therapy
* An initial preventive physical examination
* Cardiovascular screening blood tests
* Diabetes screening
* Ultrasound screening for abdominal aortic aneurysm
* Pneumococcal and influenza vaccines
* Screening mammography
* Screening pap smear and pelvic exam
* Bone Mass measurement
* Kidney disease education services

Again, I think it is interesting to note the different ailments and tests that are included here, which makes me wonder if other more specific items will pop up as this legislation takes shape.

Finally, one other thing while we are knee deep in this bill.  Remember the dustup over the 'end of life' section in the bill, which seemed to mandate that people get counseling every five years on their end of life choices?

Well that question was put to President Obama yesterday, and he left the door open to possible changes.  Here is the transcript from his AARP event.

MR. CUTHBERT: Mr. President, she mentioned, not in her question, but in her preview, that she's talking about Section 1232, the infamous page 425, which is being read as mandatory end-of-life care advice and counseling for Medicare.  As I read the bill, it's saying that Medicare will, for the first time, cover consultation about end-of-life care, and that they will not pay for such a consultation more than once every five years.  This is being read as saying every five years you'll be told how you can die.

THE PRESIDENT:  Well, that would be kind of morbid. (Laughter.)  I think that the idea in that provision, which may be in the House bill -- keep in mind that we're still having a whole series of negotiations, and if this is something that really bothers people, I suspect that members of Congress might take a second look at it.  But understand what the intent is.  The intent here is to simply make sure that you've got more information, and that Medicare will pay for it.

So, for example, there are some people who -- they get a terminal illness, and they decide at a certain point they want to get hospice care.  But they might not know how to go about talking to a hospice, what does it mean, how does it work.  And they don't want to -- we don't want them to have to pay for that out of pocket.  So if Medicare is saying you have the option of consulting with somebody about hospice care, and we will reimburse it, that's putting more power, more choice in the hands of the American people, and it strikes me that that's a sensible thing to do.

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