9 Things in the Health Bill We Should Now Reconsider

Political pundits are saying that the upset Massachusetts election of Scott Brown to fill Sen. Edward Kennedy's seat is in large part due to anger about the process of health reform: secretive, heavy handed, and peppered with grubby and unfair deals. But I wager that this has obscured the many details of the actual product the public would have to live with. As Congress takes a deep breath and reconsiders the expansive 2,700-page bill passed by the Senate on December 24 and promoted as the one that could be pushed through the House and onto the president's desk unchanged, the rest of us might want to take a closer read, too. Flip through the bill, and get a sense of just what it entails. Here are a few of the many items that pop out and are worthy of some public airing.

1. The Internal Revenue Service would be the health-reform enforcer. Once the government requires everyone to have health insurance, the IRS would move in as the monitor, proactively checking to be sure that the health insurance plans you and 300 million other Americans carry are acceptable to the secretary of health and human services. If you flunked, the IRS would impose a fine for every month you'd been lacking and use its ferocious tax-collecting skills—theoretically including the threat of jail time—to make sure you paid up.

2. The secretary of HHS would get the job of dictating uniform rules for the day-to-day operations and administration of all of the nation's private health plans, even down to the computer programs the plans must buy. Plans themselves would become enforcers, too, as they would be banned from working with doctors, hospitals, or other groups that don't provide written proof to them that they are abiding by government rules. (There's lots of uncertainty, since the rules are yet to be made.) The feds would regularly audit the internal workings of these enterprises, and deviations would trigger stiff daily penalties that could add up to as much as $20 million a year.

3. Your health records would become part of a giant national electronic medical records system. At first, doctors and hospitals would get monetary rewards from the feds for buying into a government-certified electronic medical record system. Those who didn't buy in would eventually be fined. It is not yet clear whether patients would be allowed to keep their records out of the national system, as many states are trying to arrange for their own statewide record systems. British efforts in this area may be telling: Fears of breached medical privacy have haunted the attempt to create such a system, which was supposed to have been completed by 2005. Many British patients have been resistant to signing up and were not encouraged by a survey that showed two thirds of general practitioners were reluctant to sign on as well. Privacy issues need full airing.

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