Facts for the Health Care Debate

Anyone who reads this blog regularly already knows that I am in favor of reform all the way to single payer.  However, with single payer not an option, I have been sending email and writing everyone , including President Obama, that we need to keep the public option.  I don’t believe anything will really change without it.  But the debate has really degeneated.  Things are being presented as “fact” that are not true, but once said take on a life of their own.

This week Newsweek presented a two-page spread by Sharon Begley titled “The Five Biggest Lies in the Health Care Debate”.  But I think there are actually 6.  The quotes are from Begley; the comments are mine.

1) There will be electric funds transfers out of your bank account that you will not control.

 Take the claim in one chain e-mail that the government will have electronic access to everyone’s bank account, implying that the Feds will rob you blind. The 1,017-page bill passed by the House Ways and Means Committee does call for electronic fund transfers—but from insurers to doctors and other providers. There is zero provision to include patients in any such system.

2) You’ll have no choice in what health benefits you receive.

In fact, the House bill sets up a health-care exchange—essentially a list of private insurers and one government plan—where people who do not have health insurance through their employer or some other source (including small businesses) can shop for a plan, much as seniors shop for a drug plan under Medicare part D. The government will indeed require that participating plans not refuse people with preexisting conditions and offer at least minimum coverage, just as it does now with employer-provided insurance plans and part D. The requirements will be floors, not ceilings, however, in that the feds will have no say in how generous private insurance can be.

3) Older patients and the very sick will not get treatment.  This is related to the Stephen Hawking myth.  The one that he would be dead now if he were getting benefits under the British health care system.  Only he is under the British National Health and as of this morning is alive and still doing his work.

The House bill does not use the word “ration.” Nor does it call for cost-effectiveness research, much less implementation—the idea that “it isn’t cost-effective to give a 90-year-old a hip replacement.”The general claim that care will be rationed under health-care reform is less a lie and more of a non-disprovable projection (as is Howard Dean’s assertion that health-care reform will not lead to rationing, ever). What we can say is that there is de facto rationing under the current system, by both Medicare and private insurance. No plan covers everything, but coverage decisions “are now made in opaque ways by insurance companies,” says Dr. Donald Berwick of the Institute for Healthcare Improvement.

What I don’t understand is why wouldn’t we want to know what is most effective so we can all be treated in the best, most cost effective and beneficial way.

4) Illegal Immigrants will get free health care.  I think they already do when they go to emergency rooms and our insurance premiums reflect that cost.

Will they be eligible for subsidies to buy health insurance? The House bill says that “individuals who are not lawfully present in the United States” will not be allowed to receive subsidies.

Can we say that none of the estimated 11.9 million illegal immigrants will ever wangle insurance subsidies through identity fraud, pretending to be a citizen? You can’t prove a negative, but experts say that Medicare—the closest thing to the proposals in the House bill—has no such problem.

5) There will be death panels making decisions about who gets treatment.   Related to #)3, this has been debunked all over but still lives particularly in the minds of Betsey McCaughy and Sarah Palin.

This lie springs from a provision in the House bill to have Medicare cover optional counseling on end-of-life care for any senior who requests it. This means that any patient, terminally ill or not, can request a special consultation with his or her physician about ventilators, feeding tubes, and other measures. Thus the House bill expands Medicare coverage, but without forcing anyone into end-of-life counseling.

I’ve had a lot of older relatives who have had end of life discussions with their doctors to decide on the level of treatment desired.  Everyone found them comforting and helpful to have decisions made.

6)  The government will set doctor’s wages.  I believe that one way to control costs is to put doctor’s on salary rather than fee for service which often ends up in many extra tests as the doctor and his or her practice tries to pay for equipment and up the billing.  However the proposed bills do not do this.

This, too, seems to have originated on the Flecksoflife blog on July 19. But while page 127 of the House bill says that physicians who choose to accept patients in the public insurance plan would receive 5 percent more than Medicare pays for a given service, doctors can refuse to accept such patients, and, even if they participate in a public plan, they are not salaried employees of it any more than your doctor today is an employee of, say, Aetna. “Nobody is saying we want the doctors working for the government; that’s completely false,” says Amitabh Chandra, professor of public policy at Harvard’s Kennedy School of Government.

I close with the picture Newsweek chose to accompany this story.

Town Hall Face:   An unsightly condition caused by unsanitary health-care politics

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