regular readers of my blog know that i don't comment on political or social issues (in fact i have only done so once in the past 5 years and that was on another subject about which i also feel strongly).

however, the current debate over government-mandated health care in the usa and the proposals currently before congress, is another subject on which i feel strongly. so, in case some of you might be interested to read the text of a letter that i sent to my congresswoman, representative betty sutton, and to my us senator, sherrod brown i post the contents here. i will post any replies that i receive from my congressional representatives.


8/30/2009: follow-up:

well, here we all are almost three weeks later and i have not even received an acknowledgement from senator sherrod brown. representative betty sutton's office sent an automated reply acknowledging receipt of my message, but no further follow-up from her office either. 

representative sutton did hold a telephone "town hall" meeting (barely advertised!) at which she delivered a speech straight out of the party playbook and ducked all meaningful questions.

apparently sen brown will be holding one (and only one) meeting on 1st september which, according to his website, will be
"a public forum on health insurance reform at the university of cincinnati on tuesday, sep. 1, 2009. during the forum, entitled "health insurance reform - what's in it for you?", brown will outline how health insurance reform will reduce private insurance premiums and out-of-pocket health care expenses, while giving all americans insurance options during periods of unemployment"
apart from the fact that he is clearly not seeking the views of his constituents, but merely delivering (yet another) "party line" speech, the choice of venue is interesting. cincinnati (great city though it may be) is as just about far away from all the other main centers of population in ohio as you can get and still remain in the state!

in fact, according to the last census, less than 20% of the state's population live in the "southwestern metropolitan area" (i.e. cincinnati & dayton) while more than 30% reside in the north east (cleveland/akron/canton/youngstown) and 20% in the columbus region. i have to admit that picking a location that is, at best, problematic, for more thatn 80% of your constituents to get to should reduce the chance of hearing dissenting voices considerably, senator .

looks like my basic question has been answered, these people obviously have no intention of doing anything other than representing their party. the concept of representatives basing their actions on how best to represent their constituents has, apparently, ceased to play a role in the body politic - at least for these two! 


note: this is all that i have to say on the topic (i am not looking to provoke discussion - this is merely what i sent to my representatives) and i will not accept comments on this blog article.

as a resident of ne ohio,  and hence one of your constituents, i am writing to enquire what your intentions are in respect of the current administration's headlong rush to pass "health care reform".  specifically i am interested to know:

  • whether you, personally, have actually read the proposed bills(s) and understand them
  • whether you intend to actually consult any of your constituents, or even seek the opinion of the residents, of the state that you represent – if so, when and how?
  • when you intend making a decision on how you will vote, and on what you will base that decision

as an immigrant to the united states some ten years ago and former uk resident i have personal experience of growing up and living under a single-payer, government-run, health care system. furthermore my brother-in-law is actually a general practitioner (i.e. primary care physician) in the uk's national health service so not only do i have 40+ years worth of personal experience as a user, i also have some insight from the provider's perspective.

what is concerning me now is that there appears to be a strong sense that, somehow, the united states government will avoid the errors and pitfalls that i know beset the uk system (and believe similarly affect the canadian, french and german systems to name but three others). these include, rampant bureaucracy, rapidly increasing costs, long waiting lists for even seeing a doctor and rationed care that is based not on medical judgment but on some bureaucratic 'efficiency formula' which is not even open to public scrutiny or question.

the evidence that the us government will succeed where others have failed is, to say the least, sketchy and given the government's all-round record of running large-scale operations, not terribly encouraging. as a small business owner, approaching 60 years of age, i am personally very afraid of what the proposals now apparently being considered will actually mean in practice.

for example, section 141(a) sets up "an independent agency in the executive branch of the government, a health choices administration". what exactly does that mean? especially when considered in the light of section 141(b)(1) which states that "the administration shall be headed by a health choices commissioner (in this division referred to as the ‘‘commissioner’’) who shall be appointed by the president, by and with the advice and consent of the senate"

doesn't this mean that the president is effectively going to be running the health care commission without any real oversight or control by the house/senate?

how about section 141 (c) ?

"the commissioner shall collect data for purposes of carrying out the commissioner’s duties, including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the secretary of health and human services"

what "data" is this referring to? with whom else will this data be shared? i assume that the reference is not to the secretary of health personally - but to the whole department!

i am also curious as to why section 1301 (accountable care organization pilot program), which begins by stating that:  "the secretary shall conduct a pilot program (in this section referred to as the ‘pilot program’) to test different payment incentive models"

which is an eminently sensible and laudable idea, but it goes on to say (on page 454 under sub section (4)) that:

"there shall be no administrative or judicial review under section 1869, section 1878, or otherwise of—

‘‘(a) the elements, parameters, scope, and duration of the pilot program;

‘‘(b) the selection of qualifying acos for the pilot program;

‘‘(c) the establishment of targets, measurement of performance, determinations with respect to whether savings have been achieved and the amount of savings;

‘‘(d) determinations regarding whether, to whom, and in what amounts incentive payments are paid"

doesn't this mean that there are no requirements for the pilot program to achieve anything at all and no requirement to account for how it spends money paid for "incentives" – whatever that may mean!

finally i am very interested to hear your interpretation of section 9511 (health care comparative effectiveness research trust fund) which, under section (b) on page 824 states that:

"there are hereby appropriated to the trust fund the following:

‘‘(1) for fiscal year 2010, $90,000,000.

‘‘(2) for fiscal year 2011, $100,000,000.

‘‘(3) for fiscal year 2012, $110,000,000.

‘‘(4) for each fiscal year beginning with fiscal year 2013—

‘‘(b) subject to subsection (c)(2), amounts determined by the secretary of health and human services to be equivalent to the fair share per capita amount computed under sub section (c)(1) for the fiscal year multiplied by the average number of individuals entitled to benefits under part a, or enrolled under part b, of title xviii of the social security act during such fiscal year.

the amounts appropriated under paragraphs (1), (2), (3), and (4)(b) shall be transferred from the federal hospital insurance trust fund and from the federal supplementary medical insurance trust fund (established under section 1841 of such act), and from the medicare prescription drug account within such trust fund, in proportion (as estimated by the secretary) to the total expenditures during such fiscal year that are made under title xviii of such act from the respective trust fund or account.

sounds to me a lot like "robbing peter to pay paul"!

i could go on with reading this nightmarishly incomprehensible document, but then i realized that i have representatives in congress whose function is to do that on my behalf and to make sensible decisions, based on the views of the majority of their constituents and with the good of their constituents as a whole at heart.

i mean that is the democratic process isn't it?

that is why you were elected to your high and prestigious office, right?

you do still report to us, your constituents, and rely on our support to keep you in office after the next election, don't you?

so i return to my original questions; have you read the bill? do you intend to consult your constituents (if so, when and how)? are you making your voting decision on anything other than a desire to render a partisan vote along party lines?


yours faithfully

andrew e kramek

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