In the House bill, companies would have to cover workers with federally compliant plans or pay the feds 8 percent of any payroll that exceeds $500,000. All employers would face federal audits and hefty penalties for each day of noncompliance.
Money from the young and the old. One squeeze on the young: H.R. 3200 legislates that they pay premiums that are no less than half of what older people would pay. Now, kids out of school can buy health policies for a small fraction of what their parents can, but that won't be allowed.
Medicare faces the biggest squeeze of all, providing more than a third of the money needed to make reform pay for itself. It's hard to figure that from the bill, which speaks in formulas, so go to CBO.gov, the budget office website, to see the dollars. But the program will still keep giving. The secretary of health and human services is charged with continuing efforts to decrease elders' hospitalization. The focus has been on hospital readmissions within 30 days, but this bill leaves that time open ended. This is no small consideration: Currently, 56 percent of Medicare recipients who need the hospital go back in within one year.
The bill adds a new benefit to Medicare called "advance care planning consultation." Offered free every five years, or more frequently if the patient has a chronic, progressive, life-limiting, or terminal disease or is in a nursing home, it gives beneficiaries information about living wills and a range of end-of-life services like palliative and hospice care. Some might say this is a not-so-subtle response to the fact that Medicare patients consume tens of thousands of dollars during the last six months of life. Saving that money may be hard. As any doctor knows, patients surprise you all the time. Giving up on them calls for pretty sound and well-informed judgment.
And that is what we want of our lawmakers. Before they cast what will be historic votes expected in the fall, I'd suggest that each member take a proctored, multiple-choice test on these bills, with their grades posted on the Web. Those who flunk, step aside.