Critics of Congress' efforts to reduce health-care costs and expand insurance coverage are doing Americans no good by basing their arguments on conditions in House legislation that do not exist and exaggerating others. An example would be allegations widely circulating, including among letter writers in Durango.
Mandatory end-of-life counseling? It's not there; it's optional, funded in case it is wanted. Mandatory audits for companies that self-insure their employees? That paragraph is about requiring a study of the differences between traditional and self-insured plans. There is no mention of audits, and only a sample of companies will participate.
Companies that do not provide a public insurance plan must pay a percent of their payroll to the government? Forcing a company to a public plan is not what that is about. If the owner of a company with a payroll of more than $250,000 does not want to provide his employees with insurance, then he has to contribute a percent of payroll to a fund that will.
After a week of confronting members of their congressional delegation at town hall meetings, critics who are relying on the talking points - no, shouting points - that pretend to come from House Resolution 3200 have lost their credibility.
HR 3200 is the product of three House committees and is certain to be modified before it goes before the full House and then meets the legislation that will eventually emerge from the Senate. It includes a prevention against cherry-picking by insurance companies, a sliding scale for premium amounts, a cap on out-of-pocket expenses and an attempt to determine best-practices by health-care providers. There are good reasons - success and cost, among them - for knowing what treatments generally work best.
Also included is an insurance exchange to foster plan competition and to make it possible for individuals (and companies, we assume) to more easily determine what coverage they want and at what price. Concerned about the need to save money and choosing a low-cost plan that could turn out to offer too little? An advisory health-care panel, chaired by the surgeon general, will set the floor for coverage.
A prohibition against hospital expansion? Our guess is that there are plenty of hospital chief executives who would rather be encouraged to cooperate with the hospital across town than incur the expense of acquiring every bit of new technology or adding a new wing. In any case, the prohibition against expansion in the legislation is not absolute: a committee, locally based, will be able to argue for expansion.
To receive better value from Medicare, providers will be subject to new screening and fraud detection will be enhanced.
Pointing to page numbers and paragraphs to give credibility is fine if done accurately, but that is not what is occurring. Fabricating content and injecting distortions will not help this country resolve its most serious issue.
The following are some of the assertions made in a widely distributed e-mail - along with what is actually provided for in HR 3200. Spelling and use of capitalization has been retained from the original.
Page 22: Mandates audits of all employers that self-insure.
No. This is to create a study.
"The commissioner ... shall conduct a study of the large group insure and self-insured employer health care markets. Such study shall examine the following: ... the types of employers ... the similarities and differences ... the financial solvency."
Page 50: All Non-U.S. citizens, illegal or not, will be provided with free healthcare services.
Yes and no. This prohibits discrimination. "... all health care and related services (including insurance coverage and public health activities) covered by this act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services." But there is no provision to automatically cover illegal immigrants, who in any case cannot now be denied treatment at emergency rooms.
Page 59: Government will have direct access to your bank account for electronic funds transfers.
No. This only applies if you are enrolled in the public plan: "... standards for electronic administrative transactions shall enable electronic funds transfers, in order to allow automated reconciliation with the related health-care payment and remittance advice."
Page 127: The AMA sold doctors out: The government will set wages.
No. This only applies to physicians who treat patients enrolled in the public plan. Similar to physicians' rates for those who currently treat Medicare patients.
"The Secretary shall provide for the annual participation of physicians under the public health insurance option."
Page 145: Line 15-17 An Employer MUST automatically enroll employees in a public option plan. NO CHOICE.
No. This is true only if an employer does not offer a private plan and an employee does not purchase individual coverage. "The requirement ... is that the employer automatically enrolls such employee into the employment-base health benefits plan for individual coverage under the plan option with the lowest applicable employee premium."
Page 272: Cancer patients: welcome to the wonderful world of rationing.
No. This actually increases reimbursement to hospitals treating cancer patients.
"If costs incurred by (cancer) hospitals ... exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment ... to reflect those high costs effective for services."
Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
There are exceptions to the prohibition of expansion: "... the Secretary shall establish an application process for the hospital to apply for an exception ... shall include an opportunity for community input."
Page 424 Lines 17-19 Government will instruct and consult regarding living wills, durable powers of attorney. Mandatory!
This applies to Medicare patients and is not mandatory.
" ... 'advance care planning consultation' means a consultation between the individual and a practitioner ... regarding advance care planning, if ... the individual involved has not had such a consultation within the last five years."