Myth 21. Proposed health care reform would offer more choices.
Tuesday, September 22, 2009 at 7:08PM White House spokesman Robert Gibbs used the phrase “choice and competition” three times, and variations on the words “choice” and “competition” five times each, in a 1 minute, 10 second interview with CBS’s Face the Nation, noted Mike Gonzalez. That is once every 8.7 seconds.
Kathleen Sebelius, Secretary of Health and Human Services, used one of these words or a combination only once every 16.7 seconds in a 1 min, 56 second interview with CNN’s State of the Union.
If “choice” means abortion, then proposed reforms will probably increase it, while decreasing or eliminating one’s freedom to choose not to pay for—or perform—abortions.
For people who have only one health plan offered by their employer, proposed Exchanges might increase the number of choices—within the narrow range approved by the authorities.
Proposed plans would, however, markedly reduce freedom, and eliminate many choices. Keep in mind that proponents of reform generally believe that most Americans are incapable of understanding complex medical issues—except those involving abortion or refusal of life-saving care—and are confused by having too many choices.
“Beware of choice overload,” write Richard G. Frank, Ph.D., and Richard J. Zeckhauser, Ph.D. (N Engl J Med 7/22/09). “Consumers facing complex, high-stakes choices are prone to make predictable errors.”
“Ironically, one way to enhance the prospect of informed choices is to limit the number of options,” they say.
Among the choices to be eliminated soon after “reform” passes:
True casualty insurance for medical expenses
Except for individual grandfathered plans, for as long as they survive without enrolling new subscribers or making changes in the policy, “health insurance” must meet rigid bureaucratic requirements. Insurers will not be able to price according to risk. Americans will not be allowed to save money through prudent lifestyle or personal assumption of risk as through high deductibles. Everyone will have to pay a “fair” share, based primarily on ability to pay, into the collective pot for paying everyone else’s medical expenses.
In a mailing of “facts AMA members need to know,” the AMA says it is a “myth” that “the current House bill makes private insurance illegal.” Of course the bill does not (at this time) make private coverage illegal. But it does outlaw true insurance, replacing it with prepayment schemes that function like social welfare/wealth redistribution programs.
Self insurance or sharing ministries
Americans will not be allowed to opt out of mandatory insurance and choose another way of meeting their financial obligations, as by saving, borrowing, or sharing expenses through a private, voluntary Christian community. Rather, they will all be forced to “contribute” to the revenue stream to bureaucrats, as well as to the care of the less productive, less frugal, or less prudent.
Medicare Advantage plans
Reformers have targeted these for “savings” to help fund expansions in coverage. At least one in five seniors, most of them with low or moderate income, chose to enroll in such a plan (Karl Rove, Wall St J 8/27/09 ; John Goodman, Health Alert 8/24/09).
Trading cash for better, more timely care
While “providers” may “negotiate” rates with the plan, there will be fixed payments—price controls. Reformers are very concerned about the percentage of GDP, or of a person’s income, spent on medical services. Leading-edge methods may be costly, but many would trade everything they have for a chance to extend their own, or a loved one’s life. Our representatives should “commit themselves to action that will preserve the ability of Americans to choose life over money,” writes Chris S. Karpel (Wall St J 8/17/09). That ability is threatened.
White House spokesmen promise that reform will outlaw lifetime limits on coverage. That is possible only by assuring that no one will be able to choose treatments that would make him a “six-million-dollar [bionic] man.”
Some people might be willing to pay more for treatment in a facility that has “no bureaucracy to be negotiated with the skill of a white-water canoeist.” Or one in which “there is no tension, no feeling that one more patient will bring the system to a point of collapse, and all the staff go off with nervous breakdowns.” Or one with “perfect calm in the waiting room,” where relatives are “not on the verge of hysteria” and do not “suspect that the system is cheating their loved one.”
This description applies to veterinary clinics in Britain, as contrasted with National Health Service facilities, according to Theodore Dalrymple (Wall St J 8/8/09). In Canada, human patients don’t have the right to choose private payment for “covered” services. This choice is now threatened in America, at least for those who can’t afford to pay twice, once through mandatory, costly “insurance” that they don’t use.
Unapproved tests or treatments the patient wants
Because “any reform initiative must control spending,” writes Allan S. Brett, M.D., of the University of South Carolina School of Medicine, “unproven or unnecessary medical interventions should not be available in any system” (N Engl J Med 7/29/09). “Policymakers debating health care reform should stop hiding behind the smoke screen of ‘American values’.” Those values include “individualism.”
Note that Brett does not say that government should not pay nor force insurers to pay for such procedures; he says they should not be available. Period. Not to anyone—rich, poor, severely disabled, terminally ill—no matter how desperate.
Anointed authorities, of course, set the standards for proof and necessity.
A plan that a commissioner disapproves of
According to Congressman Michael J. Rogers (R-MI), the House bill gives officials the power to disenroll an individual from his current chosen plan, or to even to disenroll all employees from their employer-sponsored plan.
Direct access to specialists
“Innovations” such as the “medical home” or “accountable care organizations” are variations on the HMO gatekeeper model. In Canada, patients must have a referral from a primary care physician to get an appointment with a specialist. In proposed Massachusetts reforms, likely to serve as a model for federal plans, all health plans would “require the selection of a primary-care physician,” and all payments would go to the organization with which the physician was affiliated. Restricting patients in this way would be a “huge change” and is a “sensitive issue.” However, “allowing a greater choice…for patients who were willing (and able) to pay more would undermine the cost-control, quality-improvement, and care-coordination purposes of global payment” (Robert Steinbrook, M.D., N Engl J Med 7/29/09).
The only choice you will have, writes Bill Turner, “is one you must make now, to give the government control over our life and 20% of the economy, or to draw the line in the sand and say no, you cannot take away my freedom” (Canada Free Press 8/19/09).
To many reformers, proposals now under consideration are but a stepping stone to their ultimate objective: involuntary universal participation in a system totally financed and controlled, even if not formally owned, by government—the “single payer.”
While the Administration has denied trying to enact single payer, Obama has previously expressed his support for the idea, and has never disavowed it on principle.
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Reader Comments (10)
All the talk and writing about the proposed Health Care Bill, I have not heard anything about Long Term Care Insurance. Seniors are paying thousands every year to help protect them in their old age for home care or nursing homes.
Anything in the "Plan" on that-have we just wasted money all these years to no avail?
Also, how many people, not seniors, are aware that Medicare is NOT FREE. Money is taken out of your Social Security every month.
Kathy makes a valid point. I write a monthly Alzheimer's column for Today's Senior magazine. I am going to try to copy my May 09 column from my files on a following response. It's not on a URL. It is one of a series of an overview of the Alz Assn 2009 Report. Many caregivers think that the govt will cover long-term care for Alz, other dementias & non-dementia patients who need it. The administration is hell bent on further bankrupting the country, and they can do it in one stroke by including those who need long-term care. People are fond of saying we are the richest country in the world, it's a disgrace we don't have govt health care. Ha! We are a DEBTOR nation--there's NO MONEY. We live on borrowed Yen. It costs 500bn a day just for the interest. One can buy long-term care insurance--which I have. As the boomers age, that's what they'll need. Proposed bills do nothing about that--oh, except for having a little discussion about end-of-life choices with the govt. No thanks! Been there, wrote the book. If it's all a matter of social engineering, things are going well--if it's about health care--they don't know what they're doing.
The cost comparision charts did not transfer completely, I'll try something else.
ALL ABOUT ALZHEIMER’S: Overview - Alzheimer’s Association 2009 Report 5-09
By Betty Weiss
The Alzheimer’s Association reports in 2009 that the healthcare costs for those 65 and older with Alzheimer’s and other dementias are triple those for non-dementia people in the same age group. Medicare payments alone are almost three times higher and Medicaid payments alone are more than nine times higher for those with dementia than for those without dementia. (Editor’s note: Alzheimer’s disease is only one type of many different dementias.)
The country is facing unprecedented medical financial challenges with a rapidly aging baby boomer population. Alzheimer’s already has an outrageous impact on Medicare and Medicaid, dwarfing everything else. The Association presents these numbers for the year 2004 to illustrate the disparity between costs of caring for those with dementias and those without dementias:
Average per person WITHOUT Alzheimer’s WITH Alzheimer’s or Payments or Other Dementias Other Dementias
Total payments* $10,603 $33,007
Medicare 5,272 15,145
Medicaid 718 6,605
Private insurance 1,466 1,847
Other sources 211 519
HMO 704 410
Out-of-pocket 1,916 2,464
Uncompensated care 201 261
*Payments by source do not equal total payments due to population averaging.
People with Alzheimer’s are high consumers of hospital, nursing home and other health and long-term care services which mean higher costs of Government programs and for millions of families. As families grapple with finances and states face budget shortfalls, Alzheimer’s threatens to overwhelm both. Most people with Alzheimer’s also have one or more other serious conditions such as diabetes or coronary heart disease. Alzheimer’s can complicate the medical management of these problems and drive costs even higher.
In 2006, Medicare beneficiaries with diabetes plus Alzheimer’s or other dementias had 64 percent more hospital stays than those with diabetes alone. An average Medicare payment for them was $20,655 while a payment for those with diabetes alone was only $12,979.
Those with coronary heart disease and Alzheimer’s or other dementias had 42 percent more hospital stays than those with coronary heart disease alone. An average Medicare payment for them was $20,780 while a payment for those with coronary heart disease alone was only $14,640.
Families provide about 70 percent of caregiving for those with Alzheimer’s and the on-going draining of finances ripples throughout the family and can be severe. In 2008, nearly 10 million Alzheimer’s caregivers in American homes provided 8.5 billion hours of unpaid care valued at $94 billion. In addition to their unpaid caregiving, families have high out-of-pocket health and long-term care expenses.
Out-of-pocket costs not covered by Medicare, Medicaid or other sources of insurance are 28 percent higher for Medicare beneficiaries with Alzheimer’s than those without. Individuals with Alzheimer’s and other dementias living in nursing homes or assisted living facilities incurred the highest out-of-pocket costs, an average of $16,689 a year!
Today, there are 5.3 million Americans living with the disease and every 70 seconds someone in America develops it. (Editor’s note: Some patients never see a doctor for Alzheimer’s and will not be counted in statistics, so there could be more.) By mid-century someone will develop Alzheimer’s every 33 seconds. By 2010, there will be nearly a half-million new cases each year; and by 2050, there will be nearly a million new cases each year.
Alzheimer’s is the sixth leading cause of death in the country, the fifth leading cause of death among those 65 and older. From 2000 to 2006, while deaths from other major diseases dropped: heart disease down 11.5 percent; breast cancer down 6 percent; prostate cancer down 14.3 percent; stroke down 18.1 percent, deaths from Alzheimer’s rose 47.1 percent. (Editor’s note: The evident rise in Alzheimer’s deaths is somewhat due to changes in the Cause of Death on current Death Certificates. Embarrassment and stigma have kept people from admitting to Alzheimer’s disease and Cause of Death was often listed as pneumonia, heart failure, or ‘after a long illness.’ More and more people are coming to understand that it is important to list ‘Alzheimer’s disease’ as the true Cause of Death to garner accurate statistics, apply for and receive additional research funding, and teach the public that it is terminal.)
According to Harry Johns, Alzheimer’s Association CEO, “Currently, there are no treatments that can prevent, delay or reverse Alzheimer’s disease…..an aggressive plan is needed now to address the threat of this disease. There are too many lives, too little time and too much at stake for anything less.”
This overview of the Alzheimer’s Association 2009 Report will continue in next month’s column. To learn more about Alzheimer’s, please visit: www.geocities.com/caregiving4alz. Betty Weiss is the author of the best selling book When the Doctor Says, “Alzheimer’s”- Your Caregiver’s Guide to Alzheimer’s & Dementia and Alzheimer’s Surgery: An Intimate Portrait.
It won't work, but the first $ figure is for those WITHOUT AD or other dementia,
the 2nd $ figure is for those WITH AD or other dementia - you can see the extreme
difference btwn the two.
______________________________________________________________________
Total pmts $10,603 $33,007
Medicare 5,272 15,145
Medicaid 718 6,605
Private ins 1,466 1,847
Other sources 211 519
HMO 704 410
out of pocket 1,916 2,464
uncompensated 201 261
Why not extend the concept of no denial, or exclusion of coverage for preexisting conditions to fire insuranc?. Why should a building owner be prevented from buying fire insurance on a building already on fire? Of course, this is absurd, but if I were a healthy 20 year old, I might put my money elsewhere. The HSA concept has many attractive provisions.
I TRIED TO GET MY STEPMOTHER LONG TERM INSURANCE SHE HAD CANCER AND THE ONSET OF DEMENTIA, ALL THE REQUIREMENTS TO GET THIS INSURANCE HAD TO BE MET, WELL SHE COULDN'T ME THE REQUIREMENTS. AS A RESULTS SHE WAS REQUIRED TO PAY OUT OF POCKET FOR REST HOME CARE WHICH AT THE TIME, 1998 WAS $3,600.00 PER MONTH AND THAT DIDN'T INCLUDE ANY DOCTORS OR HOSPITAL VISITS OR PHARMACY. THIS IS OUTRAGES, THOSE INSURANCE COMPANIES NEED TO REVISE THEIR REQUIREMENTS FOR GETTING THIS COVERAGE. AS FOR THE SMOKE SCREEN THAT OUR PRESENT ADMINISTRATION IS TRYING TO PUSH ON US IS SO CONVOLUTED IS SMELLS TO HIGH HEAVEN. THIS PRESIDENT NEEDS TO BE IMPEACHED FOR BEING IN CONFLICT WITH THE CONSITUTION, HE AS NO IDEA HOW TO RUN THIS GOVERNMENT, EXCEPT IF IT WERE A SOCIALIST OR COMMUMIST RUN COUNTRY, AND I THINK THAT IS HIS AGENDA, GOD HELP US HE WILL RUIN THIS COUNTRY.
I agree with the writer who wrote about her step mother having cancer . With all the problems that exist with our insurance companies this administration is taking advantage of the situation, but lets face it its like going from the frying pan into the fire!!!I agree that this President ,and I use that word lightly with his name, is trying to ruin this country and should be impeached for violating and totally ignoring the constitution It seems to me he makes his own rules. The ultimate was today when Kadafi said he wished this President could be Presedent for life. When a terrorist says this what is he saying about our President???????
My concern about "sharing ministries" (Christian or not) is that confused consumers desperate for low-cost coverage will rely on these groups as if they were insurance companies, even though the groups may lack the resources to pay claims."Sharing ministries" could turn out to be nothing more than a new kind of Ponzi scheme. They collect money but often stress that their payment of collected funds is voluntary and even go as far as stating that they are not to be considered a substitute for insurance.
“Whether anyone chooses to pay your medical bills will be totally voluntary,” and our plan “should never be considered as a substitute for an insurance policy.” members are told in the Christian Brotherhood’s monthly newsletter
Health Care Sharing Ministries do not assume any risk or guarantee the payment of any medical bill.
Robert Baldwin, president of Christian Care Ministry said that pending medical payments were not actually legal liabilities of the ministry.
Your use of the word ‘abortion’ 3 times in your 3rd paragraph is alarming...especially in context with your use of the words “if” and “probably”.
The following summary of the Capps amendment which was adopted, 30-28, by lawmakers who are pro-choice, pro-life, and mixed-choice renders pending Health Reform legislation abortion neutral and allows everyone to exercise their “choice” on that issue:
• The health-benefits committee (or HHS secretary) may neither mandate nor ban abortion coverage in health-insurance plans in the exchange. Plans can choose whether or not to cover abortion, as they do now.
• No tax dollars may be spent on abortion services in the exchange - even in private plans. The new system would require plans to create separate accounts, one for public funds (subsidies for low-income people) and one for private funds (which individuals will pay as premiums). Plans could use only private funds to pay for abortion services.
• In every coverage area, there must be at least one plan that includes abortion services and one plan that does not. On top of the separation-of-funds provision (above), this is an added assurance that individuals who feel very strongly against joining a plan that offers abortion can choose a plan that does not.
• Says explicitly that state laws restricting abortion, such as those mandating parental consent for minors, are not affected by the legislation.
• Says explicitly that federal laws pertaining to "conscience" are not affected by the legislation.
Gibbs is right---Health care reform would increase choice.
Most employee health insurance programs to not offer more than one choice to employees. Often the only choice available consists of a plan that requires employees to spend more than 10% of their income to exercise this choice and obtain treatment for health conditions.
HR3200 would require potential insurers to offer insurance at certain levels. These levels would significantly curtail the need for individuals to seek bankrupcy as a way to climb out from under medical bills.
HR3200 would definitely offer the choice of seeking medical care to many who are currently unable to afford it.
Here are some figures from North Carolina
17 percent of people in North Carolina report not visiting a doctor due to high costs
The number of people uninsured for an entire year in the state of NC has increased from 1.1 million in 2001 to 1.4 million in 2008. The percent of non-elderly adults without insurance increased from 17.6% to 20.5%. The proportion of workers from North Carolina without insurance has increased, from 16.4% in 2001 to 18.8% in 2008. The new Census numbers also drive home the fact that everyone in North Carolina is vulnerable to losing health insurance. An additional 46,000 people from high-income households are now uninsured.
17.2483498 % of people in North Carolina are uninsured, and 70 percent of them are in families with at least one full-time worker.
The percent of North Carolinians with employer coverage is declining: from 64 to 56 percent between 2000 and 2007.
Roughly 5.1 million people in North Carolina get health insurance on the job1, where family premiums average $12,669, about the annual earning of a full-time minimum wage job.
Much of the decline is among workers in small businesses. While small businesses make up 75 percent of North Carolina businesses, only 43 percent of them offered health coverage benefits in 2006 -- down 4 percent since 2000.
Premiums for residents of North Carolina have risen 91% since 2000. Through health insurance reform, 1,405,200 to 1,577,800 middle class North Carolina residents will be eligible for premium credits to ease this burden.
Choice of health insurance is limited in North Carolina. Blue Cross Blue Shield NC alone constitutes 53 percent of the health insurance market share in North Carolina, with the top two insurance providers accounting for 73 percent.
Choice is even more limited for people with pre-existing conditions. In North Carolina, premiums can vary based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely.
http://www.healthreform.gov/reports/statehealthreform/northcarolina.html