Health Care Reform Debate

The Health Care Reform Debate includes a lot of misinformationHealth Care Reform – Myths v Facts

8/7/09

Today – I was involved in a bit of a debate on facebook about the Health Care Reform Bill currently making its way through Congress.  One of my facebook friends, a Humanist, has concerns about the bill.  She is obviously from the libertarian wing of the Humanist movement.  A lot of Humanists are libertarians.  Just as many are progressive and liberal.  And occasionally, you get a true conservative, but they are rather rare.  Anyway – when she stated “nobody should be even implying that our 65+ should be opting out of treatment to reduce expenses on the rest of the population!” and that “none of them deserved to have "REQUIRED" end of life couseling.” I was a bit concerned that she had fallen prey to some right wing fear mongering.  After all – NO ONE would be for rationing care for our elderly or encouraging them to die to save the rest of us money.  You would have to be evil or insane to even suggest it.  So I asked her to provide the citations of which exact sections of the bill stated that elderly people would be encouraged to kill themselves or that their care would be rationed.  She provided several citations (but did not provide any that spoke to her concerns about the elderly). I then went online and looked at the bill myself (available at www.thomas.gov front page link).  What I found was that very few of her concerns had any basis in fact.  There were no citations that address elder care at all. And while a few of her concerns had some grain of truth in them, most of those were taken out of context. In short, there was only one concern that was based in fact but it was not nearly as scary as she had made it out to be when I read the offending section for myself (Sec 401.59B). In other words, I couldn’t find any of the horrible things she was concerned about in this bill. I decided to list all her concerns verbatim and what I found when I actually looked at the bill as I thought it might help others trying to make sense of this debate.  I have labelled her concerns Myths because, to me, they did not stand up as true upon reading the actual bill. The Facts listed are my responses verbatim (with the exception of the occasional parathesis – which I added here. To provide some clarity – I am only listing my opinions as facts because – that was the format this fell into. What they really are is my interpretation of what the bill says – and I encourage you to read the actual text for yourself). And again – she did not provide any citations that included rationing care for the elderly or mandated end of life counseling – so at the moment – I am going to assume this bill does not contain anything remotely similar to that and will label that as a myth as well. And by the way – I was reviewing HR 3200.

Myth: Sec. 113, Pg. 21-22 of the Health Care (HC) Bill MANDATES a government audit of the books of ALL EMPLOYERS that self-insure in order to “ensure that the law does not provide incentives for small and mid-size employers to self-insure”!
Fact: Section 113 is about allowing private insurance to alter rates based on age – but only limits the cost difference to a ratio between ages 2 – 1. So, nothing about rationing old people’s care (Her quoted statement wasn’t even in section 113.  Though to address this concern – later on in a different section entirely the bill specifically provides incentives for small companies to provide insurance in the form of tax credits).

Myth:  Sec. 122, Pg. 29, Lines 4-16 – speaks to rationing
Fact: Section 122 – is a list of benefits insurance companies must provide – nothing about rationing there either. (Consider this the minimal level of service insurance agencies must provide to qualify for the exchange)

Myth: Sec. 123, Pg. 30 – THERE WILL BE A GOVERNMENT COMMITTEE deciding what treatments and benefits you get.
Fact: Section 123 only describes the make up of the committee that will ensure that section 122 is fair for everyone, includes industry reps. Again – nothing about rationing.

Myth: Sec. 142, Pg. 42 – The Health Choices Commissioner will choose your benefits for you.
Fact: Section 142 – duties of the commissioner are to qualify plans for the program, set up the exchanges (where you go to buy insurance), manage the affordability credits and audit the entire thing – reasonable considering what they setting up that you should have one person accountable for oversite. (The HCA will decide on the minimum level of benefits required to partipate in the Insurance Exchange, the Commissioner will do the actual work of qualifying plans – you choose which plan you want – public or private – so no – the commisioner will not be choosing your benefits)

Myth: Sec. 163, Pg. 58-59 beginning at line 5 – Government will have real-time access to individual’s finances
Myth: Sec. 163, Pg. 59, Lines 21-24 – Government will have direct access to your bank accounts for electronic funds transfer
Fact: Section 163 – yeah – can see why there would be privacy concerns there – but they are trying to streamline things to reduce paperwork and wait times for approvals. EFT is enabled, but not mandatory – and nothing in there implies that standard EFT procedures would be bypassed. (In other words, the government will only get EFT’s from your bank if you authorize it)

Myth: Sec. 201, Pg. 72, Lines 8-14 – Government is creating an HC Exchange to bring private plans under government control.
Fact: Sec 201 – exchanges already exist – and are very useful tools for consumers Florida Care is such an exchange. Insurance agencies can participate or not – voluntary for them.

Myth: Sec. 203, Pg. 84 – Government mandates ALL benefit packages for private Health Care plans in the exchange.
Myth: Sec. 203, Pg. 85, Line 7 – Specifications of benefit levels for plans means that the government will define your HC plan and has the ability to ration your health care
Fact: 203 consistent with section 122 – just more specific about the commissioners duties relating to section 122 – as it relates to the exchange. (Again – minimum package benefits are listed in section 122 – plans can contain more then that – but there is a minimum level of benefits for plans to be listed in the exchange – totally reasonable)

Myth: Sec. 401.59B, Pg. 167, Lines 18-23 – ANY individual who does not have acceptable care, according to government, will be taxed 2.5% of income.
Myth: Sec. 59B, Pg. 170, Line 1 – Any NONRESIDENT alien is exempt from individual taxes. (Americans will pay for their health care.)
Fact: Sec 401 – yeah – that was part of the way to make this mandatory. If you hold coverage for any part of the year – this won’t hit you – plus – they are providing subsidies to help people afford it. Not thrilled with this – but consider it minor as I am unlikely to be affected by it. (Regarding the non-resident – they aren’t required to have insurance either – so there you go.  And we already pay for their health care for indigents anyway. This is a Red Herring that is Irrelevant to the discussion.)

Myth: Sec. 431, Pg. 195, Lines 1-3 – Officers and employees of HC Administration (government) will have access to ALL Americans’ financial and personal records.
Fact: Sec 431 – upon written notice from the commissioner – the HCA must turn over tax payer information to help determine eligibility for certain programs. Reasonable.

Myth: Sec. 441, Pg. 203, Lines 14-15 – “The tax imposed under this section shall not be treated as tax.” Yes, it says that.
Fact: Sec 441 – silly yes – but makes sense as they are talking about income for eligibility under certain provisions. Basically they are saying they will use the pre-tax income for eligibility purpose. Silly wording – but again – reasonable.

Myth: Sec. 1141, Pg. 268 – The government regulates rental and purchase of power-driven wheelchairs.
Fact: Sec 1141 amends existing legislation to be more inclusive of different types of mobility aids. Current law is more restrictive – this is a good change. (It means that in addition to wheel chairs you can now have Medicare pay for other types of power driven mobility devices)

Myth: Sec. 1145, Pg. 272 – Treatment of certain cancer hospitals: Cancer patients and their treatment are open to rationing!
Fact: Sec 1145 – amends current law to allow commissioner to compare costs between similar hospitals to make sure some hospitals are not over charging – reasonable change to current law. (Does not open up cancer treatment to rationing unless rationing occurs elsewhere in the bill – which I couldn’t find and none of her citations had any rationing provisions)

Myth: Sec. 1156, Pg. 317-318, Lines 21-25, 1-3 – “PROHIBITION on Expansion of Facility Capacity.” The government will mandate that hospitals cannot expand (“number of operating rooms or beds”).  So what will we do when we run out of beds for treatment? Who gets turned away? Not the illegals; it says they don’t pay anything.
FactL Sec 1156 – this has to do with hospitals qualifying as rural – and it basically says – if you want to expand – we need to approve you because it could change your rural status. – will not limit number of beds. (hospitals can expand if they want  – though they may loose their rural status if they do. This is designed to prevent hospital corporations from engaging in tax fraud – totally reasonable)

Myth:  Sec. 1177, Pg. 354 – Government will RESTRICT enrollment of special needs people! “Extension of Authority of Special Needs Plans to Restrict Enrollment.”If you must belong, but special needs people can’t belong, where do THEY fall?
Fact: Sec 1177 – wierd title – but basically – this section extends enrollment under current law – set to expire next year – to 2013 or 2016 – depending on the aspect of the current law. This is not a new thing – it is the extension of an existing thing. (Because this is an amendment it is not clear what the enrollment requirements are or whether they are fair- but presumably there is a reason to extend enrollment in this particular program until a review can be made to whether it should be continued given the new health care framework that is being created)

Bottom Line is this.  The stated concerns of those opposed to this bill are in most cases not valid and in some cases qualify as outright fear mongering (I am specifically noting the statements about killing our elderly – which has no basis in fact)  Clearly – there is a lot of mis-information about this bill being disseminated. If you are wondering whether what you are hearing is true or false – ask the person providing you with information to cite the specific section where the language they are concerned about is contained.  Then, read the bill for yourself. Do not rely on anyone else’s summation of what this bill contains – and that includes mine.  You can find the entire text of the bill at www.thomas.gov.  There is a link to this bill and it’s entire text at the top of the page.

One final note – the thomas.gov site has the full CBO (Congressional Budget Office) report on the financial impact of this bill.  They estimate that over the first 5 years of the plan we, the tax payer, will save $44 billion.  The 10 year projection is not nearly as good, but then, most 10 year projections are useless as they have to make too many assumptions and lots of things change in 10 years.   In other words, this plan should save us money.  Another myth debunked.


Additional reading on the health care plan: