Dx: Fear Rx: The Facts about Health Care Reform - Rationing

Under HR 3200, uninsured individuals and small businesses that can’t afford decent health insurance for their employees will purchase either a private or public insurance plan at the Health Insurance Exchange. The private plans and the public plan will be regulated and standards will be set for a minimum level of benefits that must be provided. This is important because right now the individual market is full of “junk insurance” that doesn’t provide adequate benefits. People often don’t realize they have junk insurance until they get sick and get stuck with the bills. I wrote a post at BlogforIowa.com on the problem of underinsurance based on a study published in Consumer Reports in May 2009. It seems that this definition of what constitutes a reasonable minimal level of coverage has morphed into “your health care will be rationed!”

Speaking of rationing, do any of you have private insurance? Does it cover every procedure and test your doctor orders? It is very common for private insurance companies to “ration” care by denying payment for things they deem unnecessary, no matter what you or your doctor thinks. If we want to control costs, this type of rationing may be unavoidable. Although HR 3200 provides some additional regulation of private insurance companies, it doesn’t prevent them from continuing this type of rationing. So if you are concerned about rationing, maybe you should be pushing for laws to prevent private insurance bureaucrats from coming between you and your doctor.

 ~Dr Dx

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Here are some of the false claims regarding rationing or determination of benefit packages made about the House bill, HR 3200 (you can read the full text of the bill here). The Truth comes from Health Care for America Now, one of the lead coalition groups fighting for health care reform. 

"Page 29: Admission: your health care will be rationed!"

TRUTH: Page 29 continues to define the "essential benefits package" and discusses limits on what Americans will have to spend on health care under this minimum standard. In no way does this section stipulate the rationing of care.

"Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)" 

TRUTH: Page 30 begins to describe the Health Benefits Advisory Committee which establishes certain minimum standards for health insurance plans. In no way does this committee deny treatments and benefits to Americans with health insurance.

"Page 42: The 'Health Choices Commissioner' will decide health benefits for you. You will have no choice. None." 

TRUTH: Page 42 begins to describe the Health Choices Commissioner's duties. The idea that this person will decide what benefits Americans receive is patently false, given that most Americans will keep their current plans under reform, and Americans within the exchange will have the choice of purchasing many different kinds of health plans. Rather, the Commissioner will establish minimum standards to protect Americans.

"Page 272: Cancer patients: welcome to the wonderful world of rationing!"

TRUTH: Over usage of the hot-button word "rationing" is a way to deflect attention away from the actual language of the bill and incite unjustified fear.  This section only compares costs incurred by cancer hospitals to costs incurred by similar hospitals, and adjusts payments to reduce the possibility of fraud and abuse.

"Page 335: Government mandates establishment of outcome-based measures: i.e., rationing." 

TRUTH: This provision is included in order to allow the government to base payments on practices that work.  Nowhere does it say health care will be rationed.  The attempt to isolate what works and what does not work in Medicare Advantage plans only benefits the health care system in general.

"Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals." 

TRUTH: This section only deals with how to handle special needs individuals who need to enroll outside of the open enrollment period.  Almost every type of plan operates with open enrollment periods.  This section does not create more restrictions.

Find Dr Dx right here on Blog for Iowa every afternoon for the next couple of weeks.