There are definitely more than ten, but here’s my list.
10. A federal death panel will decide who gets care and who gets ‘suicide-d’. This has been debunked almost as many times as it’s been ‘bunked’, Section 1233 of America’s Affordable Health Choices Act of 2009 amends the Social Security Act to ensure that advance care planning will be covered if a patient requests it from a qualified care provider [America’s Affordable Health Choices Act, Sec. 1233]. According to an analysis of the bill produced by the three relevant House committees, the section “[p]rovides coverage for consultation between enrollees and practitioners to discuss orders for life-sustaining treatment. Instructs CMS to modify ‘Medicare & You’ handbook to incorporate information on end-of-life planning resources and to incorporate measures on advance care planning into the physician’s quality reporting initiative.” (Media Matters)
9. Illegal aliens will get free coverage. Nope, not true. In fact, none of the plans currently before Congress would allow the federal government to provide health coverage for illegal immigrants. The federal government does not currently provide coverage for illegal immigrants.
8. It’s deficit neutral. President Obama has repeatedly claimed the current health care reform initiative will be paid for by savings, increased taxes on wealthier Americans, and reductions in Medicare Advantage and other payments. I doubt it. Providing coverage to tens of millions of folks who don’t have it now will increase utilization – just like it did for Part D – and we can probably expect prices to go up too.
7. Health reform will lead to rationing. Again, I guess it depends on your definition of ‘rationing’. If ‘rationing’ will reduce the amount of unnecessary and probably hurtful care, that’s a great result. According to the Dartmouth Atlas, about a third of the health care delivered to Americans is not necessary and wasteful. I’m fine with eliminating that care – even if that means I can’t get an MRI on my twisted ankle. That’s not rationing, that’s good medicine. Unfortunately, I don’t see that happening anytime soon. And therein lies the problem with the ‘deficit neutral’ argument – more coverage will mean more services which will cost more money, driving up the nation’s health care cost.
6. The free market which can solve the problem without government intervention. I’d agree (and have stated before) that the private insurance market could fix our health insurance problem, but there has to be a market first. The reality today is that almost every market is already dominated by a very few health plans, so much so that in most markets, there really is very little market competition amongst health plans. Until and unless we have open competition, we won’t have choice.
5. This is socialism. Well, I guess it depends on your definition of ‘socialism’. According to generally accepted definitions, socialized medicine is when the government employs the doctors and owns the hospitals and provides the insurance. None of the bills under consideration are anywhere close to that -which, BTW, exists in a relatively few countries like the UK and Cuba. In the proposed system, private insurers would continue to provide insurance to most non-seniors, Medicare would continue, and providers would remain independent.
4. My tax dollars would be used for abortions. Yes and no. Federal dollars for abortions are currently quite restricted, and would continue to be. Coverage for abortion services would remain only for rape, incest and to protect the mother’s life.
3. We should just can all the private insurers and go to single payer, which will save lots of money in administrative expense. Not true. Private insurers have to account for and report future liabilities; the government doesn’t. The ultimate liability for Medicare and Medicaid is in the tens of trillions of dollars. Moreover, the admin expense argument is unfair as the Medicare population is markedly different from the demographic served by private insurers. First, there’s only one enrollment per lifetime. Second, there are minimal marketing/advertising expenses. Third, there are no premium taxes or other costs of compliance. No, while admin expenses would be lower, the huge savings touted by single payer advocates result from an unfair analysis.
2. A public plan would crush private insurers and we’d all end up covered by the public plan. Not even close to the truth. Some continue to complain private health plans will not be able to compete with a public option as the public plan will just dictate pricing to providers, and public plans wouldn’t have the capital and financial stability requirements forced on private plans. They’re half right. Re the capital requirements, they’ve got a valid argument. As we know all too well with Medicare and Medicaid, the Feds (and we taxpayers) have an ultimate unfunded liability in excess of $22 trillion, but that figure doesn’t show up on any formal financial statements.
But when they complain about pricing, that’s a red herring – for two reasons.
First, physicians don’t have to accept Medicare or Medicaid, and wouldn’t have to agree to any ‘public option’ pricing. In fact many docs don’t accept Medicare today. As participants in the free market, they are able to opt out if they feel the compensation is too low – and many do.
The other factor is just as simple – pricing is but one component of the health cost equation. The others are utilization and frequency. ‘Utilization’ is the number of a specific type of services used by a patient, while ‘Frequency’ is the percentage/number of patients that use that type of service. And Medicare has not shown any ability to address either of these two factors.
1. And the top misperception about health reform – it will mean a bureaucrat will determine my health care, not me and my doctor. Uhhh, what do you think happens now?
Pull out your health insurance card, and turn it over. See the phone numbers on the back? Those connect you (first to voice mail hell), then eventually, if you’re lucky and very persistent, to a ‘bureaucrat’, albeit one employed by your health insurer. They might even be located offshore …
Aug
17
Actually, some insurance companies do have nurses and doctors making decisions about health care.
My physician works for the health insurer as a consultant. He reviews member files to see if what a treating physician makes medical sense, or if he is trying to run up the bill.
A friend of mine is an R.N. and works for Blue/Blue Shield of Illinois. While she’s not the one that answeres the phone when a member calls, she is the one that doctors and nurses speak to, when deciding if a patient should be treated in-patient or out-patient, or whether a patient needs another day of hospitalization.
Joe, I agree with some of your points and disagree with others. Yet, here is the one that really sticks with me. In Item #5, I just see it different. Socialism is the spreading of wealth from the wealthier to the less wealthier. It’s an attempt to level everyone out economically. Ultimately, if it’s today or tomorrow, the cost of Obamacare is going to require taxes on all, and heavy taxes on the so called Rich. The end result is going to be a form of socialism.
I read your post with interest, as your Northeastern views just are different than my Tennessee views. In the South, we are still very protective of our individual nature and choices. I have just come to the conclusion that first people are wired differently and second the Northeast somewhere along the way lost the very heart and soul of the original American Revolution.
Illegal aliens will get free coverage. Joe, have you heard that there is a provision in one of the bills that prohibits a provider from inquiring about citizenship or status? That would seem to effectuate much the same result as expressly covering illegals.
Jim – thanks for the comment – even though it is wrong on two levels. First, which bill contains that language? Where?
Second, you confuse ‘coverage’ which is an insurance function, with the patient-provider discussion, which is a health care function. If, and it’s a big if, there is any language in any bill such as you describe, it has nothing to do with ‘coverage’.
Brian – thanks for the comment. I’d note that your definition of ‘socialism’ is unique to you, and if you want others to understand what you are saying you may want to use terms consistent with generally accepted definitions. Otherwise communication is rather pointless.
re our locations, there are so many erroneous assumptions in your second para I don’t know where to begin. First, I’m not from the Northeast originally. Second, there is a wide divergence of opinions in New England; there isn’t a ‘Northeastern view’. Third, I am very protective of my ‘individual nature and choices’; unfortunately the current healthcare market severely limits them due to laws that allow medical underwriting and other risk selection techniques. Fourth, be careful wrapping yourself in the flag. Over the last eight years ‘patriotism’ has been used by many to justify reprehensible actions. And remember what Samuel Johnson said about patriotism.
I am also from TN – and unfortunately most people down here are like Brian – they are against “socialism” of any form. But they send their kids to public schools, participate in public recreation leagues, camp in state and national parks and their parents receive social security checks every month and get their healthcare through Medicare – but other than that by God they are an independant self sufficient lot. Oh – and TN is a welfare state – we recieve much more in federal money than we pay in. As for the healthcare reform – I think that they should open Medicare to all – but they need to start doing UR to limit over treatment. They also need to stop basing provider reimbursement on proceedures and base it on some other metric – which would immediately cut down on overtreatment.
Insurance premiums are established based on healthcare costs plus the insurers profit and overhead. Insurers are required to publish their “loss ratio” this is the amount that they pay out in claims for every dollar collected in premiums. In California most of the top insurers have loss ratios between 78% and 82%. That means that out of every premium dollar collected about 80 cents is paid back to the insured in the form of claims paid. This leaves 20 cents out of every dollar to cover the insurance companies overhead, taxes, employee salaries, profit etc. Anthem Blue Cross makes about 3 cents profit out of every dollar collected. I am sure you will agree that is not too much.
The problem that we have is “health care costs” spiraling out of control. This is hospital charges, doctor charges, drug charges etc. As these charges go up so does the cost of insurance. As the cost goes up fewer people can afford insurance so the insurance companies must find ways to bring down the cost of insurance, this they have done by reducing the coverage offered by their plans. So this has created a situation where cost for insurance goes up, but benefits decrease. For some reason many people do not see much beyond this point and blame the insurance companies for all of the problems in the industry.
However, you do not need to look very hard to find the reasons for the rising healthcare costs.
They are:
· The GOVERNMENT reports that it losses 30% to Medicare fraud…The government collects taxes to cover Medicare and 30% of the total collected to cover Medicare is lost to fraud. This is staggering! In 2010 that will amount to about $200 BILLION.
· Hospitals over bill millions of patients every year. It is almost accepted as a normal practice nowadays. But this practice over billing is costing us all billions of dollars per year. Hospitals make it very difficult to price comparison shop their services. I have called many hospitals and asked the price they charge for various services or medications and more often than not they will not give their price information.
· Defensive medicine. Medical providers in fear of been sued make sure they cover all bases by ordering every test and procedure imaginable.
· Waste in medical practices. As an example at my local hospital when nurses are dispensing insulin, they draw one dose out of the vile for the patient then throw the vile away. But they charge the patient for the whole vile. What they should be doing is sterilizing the needle before inserting it into the vile, taking what they need and putting the vile back on the shelf. A vile of insulin costs thousands of dollars!
· Obesity. It is now official, 40% of Americans are obese. And this 40% of the population costs 40% more in medical treatments than the rest of the population. We have to take responsibility for our own health.
· Hospitals are required by law to accept all patients whether they have insurance coverage or not. Many people who do not have insurance coverage visit the emergency room for simple things that could be handled in a doctor’s office. A very large percentage to these charges go unpaid, so the hospitals passes these costs on to those with medical insurance coverage. With nearly 50 million uninsured this is a major cause of escalating hospital charges.
These among others are some of the reasons we have a broken healthcare system. PricewaterhouseCoopers recently estimated that our current system wastes about $1.2 TRILLION per year, that is 50% of the total cost of our healthcare system.
This is why it makes no sense when the current administration talks of health INSURANCE reform. Do not get me wrong, insurance companies are not blameless, but they are not a major contributor to the problem.
This is why if the government continues on its current path of health insurance reform it will not fix the problems in our system. All it will do is the further bury the problem, we will all then be tax more to cover the unseen problems.
Everyone seems to overlook an important bureaucratic layer. Every state has a regulatory body that manages every insurance company and policy – often in a most intrusive manner. Check your state and you may find they control rates, forms, and almost everything about your health insurance. If your insurance plan sucks, it does so because politicians have allowed it to suck!
Joe I really appreciated this post, as well as several very informed and intelligent responses. Thank you all for taking the time to share your insights. For the record, I’m a conservative and I WOULD like to see some sensible reform. What does scare the bejesus out me is congress and the President taking on such an important task but trying to rush it through, and without the famous “transparancy” we’ve been waiting for. I would really love to see a system where we owned our health policies the same way we do our life policies and where healthcare fees and services were more open and competitive. For those that can’t afford any premium, I could support some government financing of free/nearly free clinics for basic services. As pointed out, what’s the difference between this and government financed public education? Just make sure it doesn’t crowd out or eliminate my freedom to get premium services if I can afford it.
As written in HR 3200, the public option would be exempt from state premium taxes, and the public option would be required to undercut private reimbursement, so there is an automatic price advantage right there.