Let’s get this straight. We’re going to be gifted with a health care plan we’re forced to buy and fined if we don’t.

It purportedly covers at least 10 million people without adding any new doctors, but does provide for 16,000 new Internal Revenue Service (IRS) agents.

It was written by a committee whose chairman said he doesn’t understand it, passed by a Congress that didn’t read it since its members exempt themselves and signed by a President who smokes.

Funding is administered by a Treasury chief who didn’t pay his taxes.

It will be taxed for four years before any benefits are seen.

By a government which is almost bankrupt already by Social Security and Medicare.

All overseen by an obese Surgeon General and financed by a country that’s broke.

“What the hell could go wrong?” Maxine grumps.

Perhaps it takes a cartoon character to capture some of the absurdities associated with the burning political issue of our time, playing out this week as House Republicans, including U.S. Rep. Fred Upton, debate legislation to repeal “Obamacare.”

“The bill is not real good news for Michigan employers. The act is going to drive health care costs higher and it’s going to raise premiums and taxes for all of our employers in this state,” Dean Johnson said.

Johnson, of Kemner-Iott of Cass County, an 80-year-old employee-owned insurance company with an agency in Cassopolis, in briefing Dowagiac Rotary Club Thursday noon at Elks Lodge 889 on the massive Health Care Reform Act, also quoted a Texas judge who wrote in the Wall Street Journal, “It’s unbelievable our Congress could come up with a bill loaded with so many wrong-headed elements.”

“He’s blaming both parties for this,” Johnson said, ticking off some examples, citing such sources besides Maxine as Kiplinger Tax Reports, the Congressional Budget Office, the Department of Health and Human Services, U.S. Rep. Mike Rogers of Michigan and the Small Business Association of Michigan.

On page 52, the bill provides health insurance for everyone in the United States — even if they’re here illegally.

On page 59, “This is a real killer that scares me. The government will have real-time access to my bank account and to make electronic fund transfers. If they send me a bill because I’m not in compliance with health care, they can just go take it out of my bank account.”

“Here’s another one that kills me,” he said. “The plan will be subsidized by the government for all union members, union retirees and community organizations, such as ACORN.”

“This one I don’t understand at all,” Johnson related, “but on page 203, lines 14 and 15, ‘The tax imposed under this section will not be treated as a tax.’ Page 241, the doctors will all be paid the same fee regardless of their specialty and the government will set all doctor fees. Page 272, cancer hospitals will ration care according to the patient’s age. And the government will impose a prohibition on all hospital expansions.”

Page 425, lines 4-12, “Here’s another one a lot of us are going to have to do,” he said. “The government mandates advanced care planning. Those of us on Social Security will be required to attend end-of-life seminars every five years.”

Page 429, “The government will specify which doctors can write an end-of-life order. His final comment is that it specifies that this bill will not apply to any members of Congress. They have a well-funded private plan that covers their retirements. If they were on Social Security and Medicare, he believes they’d find a pretty quick fix for a financially sound future. As we get more Medicare benefits, our premiums have all gone up. Additional benefits mandated by this act will cause health insurance premiums to increase this year.”

Joy Strand, Borgess-Lee Memorial Hospital administrator, said their analysis of changes was that over four years, the Borgess system would receive $100 million less through reimbursements.

“When you look at escalating costs with reduced payments,” she said, “we really have to look at changing the way health care is delivered if this bill stays the way it is.”

Given that repeal is likely to die in the Senate, “Probably the greatest hope we have is to get it repealed by all of the lawsuits filed by the various attorneys general in the states,” including Michigan, Johnson said.

“Those of you who reached the Medicare doughnut hole in 2010, you got a $250 check. They also established a $5 billion temporary reinsurance program created for employees who had retired over the age of 55, but were not eligible for Medicare. That program has really never quite gotten off the ground. They also established a $5 billion pool for high-risk health insurance for people who could not get insurance because of pre-existing conditions. It’s working in Michigan, but not very well, because the premiums are almost beyond what people can afford to pay. One new rule bars insurance companies from canceling a policy for anything other than fraud. But if you don’t pay your premium, they can’t cancel you, either. And they can’t deny coverage to children with pre-existing conditions, which is a good idea, and they’ve taken the lifetime cap off. Hardly anyone ever reached that cap, but it does happen in some instances.

“If I have a child under the age of 26 — married, in school, with 10 children — I can put that child on my group policy, but not his children or his spouse. They added a lot of preventive services, so we’re all going to get a lot more benefits along that line. Also, in 2010, they had a small business tax. If you were in business with 10 or fewer fulltime employees, earning $25,000 a year, you’re eligible for a 35-percent tax credit based on the health insurance costs if you contributed as an employer at least 50 percent of the premium. That could be a benefit for small businesses, yet it appears it’s only going to help 10 or 12 percent. Indoor tanning services now have a 10-percent tax.

“Another thing that came up is insurance companies must spend at least 80 percent of your premium dollars on medical care. Health insurance companies are the least profitable in the industry. Some were already spending more than that. They’re working very hard to build up reserves to pay these benefits, so premiums are increasing. We saw premiums increase on group health insurance Jan. 1 from 13 to 66 percent. Where’s that money come from? They also cut our commissions by as much as 50 percent to build up reserves.”

Looking ahead this year, “Health savings accounts, there used to be a penalty of 10-percent penalty if you used the funds for things other than health care. Now there’s a 20-percent penalty. Flexible spending accounts, they’ve made a lot of changes in that — particularly in the area of drugs. They’re going to develop a long-term care program. If you contribute for four years, you’ll end up having a $50-a-day benefit when you go into long-term care. Contribution amounts have not been determined, so that’s another one that’s out there in this room full of feathers. It hasn’t landed anyplace.

“Community health care centers are going to increase funding by $11 billion to provide medical care to patients who cannot afford it. This year, the doughnut hole for Medicare, during a period of time you’ll be able to buy brand-name drugs at a 50-percent discount. That doughnut hole’s going to be phased out and will be gone by 2020. Malpractice, they’re providing funding appropriated to the states over a five-year period to develop alternatives to the current system. Wellness programs, funds are being appropriated over five years to employers to offer benefits to their employees.

“I don’t know how it got in there, but employers now have to complete a 1099 form for every business transaction over $600. When I buy $600 in gas to run my lawnmower business, I’ve got to look up that gas station and give him a 1099. It’s really going to put a lot of paperwork in the hands of people who are not good at paperwork. For our company, when we buy office supplies, we’ve got to find that person we bought those supplies from to file a 1099,” Johnson said.

Hiring 16,500 new IRS agents for $10 billion represents “the biggest expansion since World War II, Johnson said. “They’re going to collect over $500 million in new taxes. The IRS now is going to be in charge of monitoring both individuals and businesses to certify we have health care.”

Flexible spending will be limited to $2,500 annually.

“That will work in a lot of instances,” he said, “but one of the big reasons was to use those monies for day care and for special-needs children to go to school. I have a special-needs nephew whose school costs $14,000 a year, even though he lives at home, and they were paying that through this flexible spending account. That’s going to go away. Another thing that’s going to hurt all of us who itemize deductions is that threshold of 7.5 percent of adjustable gross income. Before you could itemize or get any credit for unreimbursed medical expenses, it’s going to raise up to 10 percent. Our Medicare taxes are going to increase by .9 percent. A first-time tax on investment income, so if you’re getting $1,000 a month, you’re going to pay a 3.8-percent tax on that. Probably another $400 you’ve never had to spend before. Excise taxes, 2.9 percent on taxable medical devices.

“In 2014, they’re going to require that every citizen and legal resident have qualified health coverage or be subject to a tax penalty. If small businesses buy their health coverage through an exchange and pay at least 50 percent of the premium, tax credits of up to 50 percent of the employer’s contribution will be allowed. But studies show only 12 percent of the companies are going to qualify, so it’s not a great big deal.”

Of vouchers, Johnson commented, “400 percent of the poverty level is $56,160 for an individual, $117,304 for a family. Probably most of the people in Cass County would qualify for that. They’ll vary from $4,500 to $5,500 for an individual, $9,400 to $11,500 for a family. Somebody’s got to pay for that. They’re also going to restrict insurance companies from setting rates based on pre-existing conditions. Premiums can only vary because of geographic location, age and tobacco use. In the past, if I was a diabetic, I probably had a tough time getting health insurance unless I went to Blue Cross Blue Shield of Michigan. We’re kind of spoiled in this state because we had a company that would take you irregardless of any health issues.

“In Indiana and other neighboring states, they didn’t have that. They’re all going to be guaranteed-issue policies, meaning that if you make an application, the company has to take you. What’s that going to do to the premium? It’s going to drive them up. They’re also going to create an essential benefits package that’s going to tell what’s going to be covered and how. That alone is probably going to drive premiums up by 13 to 15 percent. They’re going to limit the deductible to $2,000 for individuals and $4,000 for families. Probably not a bad idea, but we’ve got some families and some individuals who have a lot of money and they’ve got $5,000 or $10,000 deductibles and they’re just using this insurance for catastrophic loss. That’s going to end up going away. Waiting periods, they’re going to limit those to 90 days. Then this health insurance exchange, businesses, if they have 100 or less employees, businesses can purchase qualified coverage. Then if you buy your health insurance through this exchange, there are going to be tax credits worth 50 percent of the amount you spend. Where’s that money going to come from? Get your wallets out, guys.”

Medicaid expansion for low-income citizens under age 65 would be at 133 percent of the poverty level. “Now, an individual making less than $18,673, they could qualify, a family of four making $39,000 or less,” Johnson said.

“They’re going to get annual fees from insurance companies, $8 billion in the first year this year. Then they plan on getting $47 billion from 2014 to 2019. After that, they’re going to get $8.8 billion a year. Where’s that money going to come from?

“Insurance companies only have one way of getting money, and that’s premiums charged to you and to me. They’re also going to get an annual fee from the drug companies, $2.5 billion in 2011 and $2.8 billion each year thereafter. Drug companies can only get money charging users for products. Penalties for the requirement to have health insurance start out at 1 percent of their income, families, $95 for each adult and $47.50 for each child under the age of 18. Subsidies for lower and middle-income people, such as a family of six making $50,000, will end up $5,800 in 2013 and increase each year by about 25 percent. In 2018, there’s what they call a ‘Cadillac tax,’ an excise tax on health insurance plans with values of $10,200 for individuals and $27,500 for families. If Patti has a plan at our company we’re paying $1,000 a month for, she’s going to end up paying a 40-percent tax on that. That’s on the amount of the benefit the company pays.”

Johnson, whose has a son who is a doctor, asked friends with a clinic in suburban Detroit the profile of their typical patient. “Cash-paying Canadians,” came the reply.

“They can’t get services up there, so they come here and pay cash. Not all Canadians can do that, but people who have the money do. Something needs to be done. We weren’t right before, but I’m not sure we’re right here. Keep your cards and e-mails going to your senators and congressmen and plead and cry with them to make some changes. It’s not going to hurt me much because I’m an old man, but I’ve got 28 grandchildren and great-grandchildren. That’s who it’s going to hurt. Why would I support putting this big burden on those little children?”

Southwestern Michigan College Board of Trustees Chairman Dr. Fred L. Mathews, who began reading the convoluted legislation, commented, “It’s impossible to amend that monstrosity. The government would be able to read into it anything it wants, and you’ve probably touched on maybe one-half of 1 percent of what’s in there that will control everything we do in life. It needs to be scrapped and replaced with the good parts, which you could probably do in 100 pages. It was 2,800 pages when they started in the mock-up that no one read. It’s now been boiled down to 957 pages, single-spaced. Except for a few things, administrative rules have not been written yet. I’ve been involved in legislation for years and years. There are typically three to five pages of rules for every page of law, or 2,000, 3,000 or 4,000 more pages … When they get through, your whole life is going to be controlled. I agree we need health care reform, but it needs to be simplified so we can all read it.”

“We’re probably putting our lives in the hands of people who aren’t truly qualified to write some of these bills,” said Johnson. “I’m not going to talk politics because I don’t do that in public.”

But “If you look at our president and who he’s gathered around himself, he only has two or three business people who are advisers. The rest are all school teachers, and I’m not putting them down because I come from a family of school teachers, but they know how to teach — not run a business. The sad part is those of us who are 70 and above and have cancer or need a bypass in the future, we’re probably not going to get it. That’s happened in Canada and the UK (United Kingdom),” where he lived for a few years. “I had a man who worked for me who got sick and it took him over three months to get a doctor appointment. Meanwhile, he died from something that could easily have been prevented.”

“I don’t want to paint it all doom and gloom,” Johnson said. “There are some items in there that will help some people, but it’s going to hurt the majority who are going to have to pay more taxes and larger premiums.”

“If the government’s going to do all this, why is it not also coming down on insurance companies and drug companies and capping what they can charge?” asked retired social worker Marilu Franks. “They’re making billions in profits.”

“They are, in a way,” Johnson said. “The government’s charging drug companies billions. They’re making billions, but they’ve invested billions. I’m not here to support the drug companies, but if they don’t have these large profits, they’re unable to create new medications some of us are going to need. It’s a vicious circle, but what we’ve done by passing this bill is that we’ve given them the opportunity then to charge us more because they’re going to have to get more money to meet these fees they’re going to have to pay. So it becomes a vicious circle. It will all end up coming out of our back pocket — or front pocket or purse.”

Johnson said, “Starting in 2011, you’re going to have a new item on your W-2 form. You’ll be paying taxes toward the amount your employer contributed toward your health insurance premiums.”

Dick Judd of Judd Lumber Co. said his company shoulders 60 percent of health care costs, employees 40 percent.

“The 60 percent we pay is going to be taxed?” he tried to clarify.

“It’s not,” Johnson then said. “It has to be listed on the W-2, but it’s not taxable at this point. It’s an information-gathering tool for the IRS to see how much employers are paying.”

“But did you not say that the employee, who has 60 percent of their health care premium paid by their employer would have to declare that as income?” followed up retired school superintendent Larry Crandall. “Because there’s been discussion for some time about taxing health care premiums paid by employers.”

“We’re all going to feel it one way or another,” Johnson said. “If it’s not taxed, we’re going to feel it paying premiums for our providers to meet these additional fees. States that have high-risk programs hardly ever make any money and usually end up being subsidized by the states. Indiana has a program where they can’t turn you down and you have to have been turned down by an insurance company” to qualify for the program.

“The coverage is wonderful, but the premiums are high and it usually attracts a group of people that demand a lot of health care. As a result, they’re really never able to balance it out, so it’s a program that’s bailed out every two or three years by the state of Indiana.”