The U.S. Senate recently began debate on the controversial health reform proposal, called the Patient Protection and Affordable Care Act. Arguments have been raging for months, in the media and in people's living rooms, about healthcare reform yet few people understand the specifics that are being proposed.
Giving unlimited care to all Americans would be ideal. Performing bypass operations on all 90 year olds who needed them, offering experimental, and thus painfully pricey, chemotherapy to anyone regardless of the chance of success -- this is what we want. But there is an uncomfortable tension between what patients want and what the insurers, be they private or government, can afford. It's like having Ferrari tastes on a Toyota budget. Or perhaps it is more akin to offering a filet mignon dinner to your entire church or synagogue. A few friends may get steak at your home dinner party, but large groups of parishioners tend to get spaghetti.
Careful assessment of the health reform proposal currently in front of the senate reveals, not surprisingly, both good news and bad. For example, there are provisions prohibiting insurance companies from imposing lifetime individual spending limits and dumping of patients who are too expensive. These are important patient protections. However, there are also hidden restrictions that may ultimately limit coverage for important healthcare services. The section on preventive care is one example.
The section on preventive care has a hidden limitation that is likely to escape the notice of non-physician Senate reviewers. It states "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of `A' or `B' in the current recommendations of the United States Preventive Services Task Force."
That is, health insurers must pay for preventive services that the U.S. Preventive Services Task Force (USPSTF) recommends. On first glance this seems like an important patient protection, and in fact it is a great start. However, as was recently revealed when the USPSTF withdrew its recommendation that women under age 50 get regular mammography, this organization is imperfect. Many cancer support organizations and physician associations disagreed strongly with this position. Yet, as the health reform proposal is written it is the recommendation of this group that would determine insurance coverage for preventive care such as breast cancer screening.
It is worth noting that the USPSTF is a government agency. Medicare and Medicaid, who spend billions of dollars on healthcare coverage, are also government agencies.
Isn't this a bit like having the wolf watch the chicken coop?
Comments
I would much rather have the government decide what care I can have instead of an insurance company. Mammograms will be included as preventitive care for women between 40 and 50, but even if they weren't, they are not that expensive if you really want one. Just like abortion is not that expensive if you have to pay for it yourself. With the money that people will save on premiums if health care reform passes, they will have more money left over for other spending including any preventitive care they want that is not covered. But the government standards will be much better as far as providing access to the care that we need than insurance companies presently are. No matter what is included or not included as preventitive care, the average citizen will have greater access to care than they do now.
John,
You're an idiot. Did you seriously say that you would rather have the gov't decide what care you have? The gov't runs things into the ground by poor business practices, just look at the post office and tell me how well that's run.
Fraud, waste, and abuse are major issues. Consumers (you and I) as well as Doctors and Dentists are the guilty parties there.
Good point to raise, Delia. The difference between having private insurance and a public plan is that of necessity the public plan tends to become a one-size-fits-all that never actually fits anyone. And you are exactly right that it is like having the wolf watch the chicken coup. Former Sen. Tom Daschle's ideas permeate at least some of the versions of this bill, and his book advocates strictly limiting care, especially to elderly people. There is much more about intrusive government control in this bill than there is about actually providing healthcare for the 10 million odd people who really need it. The 47 million number is vastly inflated.
The number of uninsured is not inflated. As a matter of fact, there are many others, such as myself, on the verge of not having insurance due to cost (over $900 per month). The numbers are only going to rise if we don't reign in costs soon. An excellent book is "Hope or Hype" by Richard A. Deyo MD and Donald L. Patrick PHD. This book shows exactly why our health care costs are so high. We do need government intervension to get the fraud in the private industry under control and we do need a panel to study which treatments really work best and not just what is being promoted by the health care industry in order to make big bucks. Yes, I want to know what works best and have access to the best treatments which are often the older well proven treatments that are no longer being promoted because they are no longer profitable. I trust the government over a corporation that is trying to profit by selling products that are not necessarily the best or safest but the most profitable for them.
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