The House health care reform bill, H.R. 3200, will do more than feed the rapidly growing tumor of the federal deficit. It will cause small businesses to hemorrhage and carve a pound of flesh from patients forced to navigate the new bureaucracy it creates.

Some pundits have suggested that this plan is not the president’s. But for this to be true there would have to exist a wholly independent Congress capable of generating a 1,018-page bill without the consent of the commander in chief whose top priority is health care reform.

Small business – payroll trauma

H.R. 3200 imposes a “pay or play” mandate with a new 8 percent payroll tax on employers not providing health insurance – including any employer with 10 or more employees and an annual payroll over $400,000. Businesses with a $250,000 payroll would see a lower tax hike.

For employers already offering health coverage, the mandate would still apply if the employer pays less than 72.5 percent of premiums.

The employer mandate burden would fall heavily on low-income workers who are currently uninsured (higher-wage workers are more likely covered under the present system). The payroll tax would force employees to take the equivalent of an 8 percent pay cut – $1,600 per year for a $10-an-hour worker.

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Under the guise of funding health care by socializing its costs, H.R. 3200 levies a fine on any individual with an income of $280,000 before deductions. This “tax the rich” proposal declares fiscal war on small business owners without incorporated status.

These taxes are estimated by the National Federation of Independent Business to affect two-thirds of all small business profits in the U.S. Manufacturing is likely to be hit hardest, as 68 percent of all American manufacturers file taxes as individuals.

Already anticipating inadequate funding for the $1 trillion proposal, legislators plan to insert language that would increase this tax in 2013 if health care system cost savings don’t materialize.

Patients – injured access

For those whose lives depend on quality health care and who believe that medical decisions are best made privately between patients and the doctors who care for them, the consequences are not simply financially unhealthy.

H.R. 3200 rewards middlemen paid to deny medical care recommended by a patient’s physician. These political appointees, charged with “Comparative Effectiveness” determinations, would make treatment recommendations far from the exam room without ever having examined the patient whose treatment is denied.

President Obama’s budget chief says that the proposed legislation isn’t going to add $240 billion to the budget deficit – so long as Medicare payments to physicians are cut 21 percent next year as scheduled.

Physician payment reductions are “sort of already baked in to our fiscal trajectory,” claimed the Office of Management and Budget director.

No estimate was offered as to the effect this cut would have on access to medical care in rural and underserved regions of the U.S. or the sustainability of doctors’ practices already struggling to stay afloat.

Patient choice is another casualty of H.R. 3200. The effect of the bill’s new bureaucracy, a public (government-controlled) health plan, is described by The Lewin Group. Over 88 million workers would be shifted to the public plan from private coverage. Yearly premiums for individuals with private coverage would increase as the result of cost shifting from the government-sanctioned plan.

To the needs of older Americans, the bill mandates an “Advanced Care Planning Consultation” in which senior citizens must meet at least every five years with a doctor or nurse practitioner to discuss “dying with dignity.”

While consultation with a physician does constitute medical care, it is unlikely that a forced discussion of death is what an elderly patient needs most.

Supporters of the bill defend its promise to cover the poor and uninsured. However, unlike the new taxes proposed in the legislation, neither Medicaid expansion nor subsidized coverage would take place until after the 2012 presidential election.

H.R. 3200 is silent on one of the significant cost drivers in health care: frivolous lawsuits. Ignoring the need for tort reform fulfills the president’s campaign treatment of the current medical malpractice system, in which doctors are seen as ATM machines and awards to genuinely harmed patients are raided by trial attorneys.

If the health care reform enacted looks much like HR 3200, the U.S. economy will bleed jobs. And although all bleeding stops eventually, it is often at great cost to the patient.


Dr. Linda Halderman was a breast cancer surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice’s closure. She now serves as a policy adviser in the California State Senate.

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