The healthcare reform debate has become ugly (see my post Town Hall Astroturf Protests and the “Birthers”: The ugliness of racism and hatred) and it is clear that the myths from those in the pockets of the health insurance industry and the racist hate based town hall protests are flying.
So let’s look at this rationally and objectively point by point. Healthcare reform is a huge issue and it cannot, nor should it be, a campaign of bumper sticker slogans. It is hard, it is nuanced, it is complicated and it deserves being analyzed with respect.
AARP, hardly a radical left wing group has developed a site- Health Action Now!- which details the current situation and the tactics being used by those hell bent on derailing healthcare reform. Here’s what they say:
There are special interest groups trying to block progress on health care reform by using myths and scare tactics. Like the notion that health care reform would ration your care, hurt Medicare or be a government takeover. Actually, these are false statements.
All of the health care reform plans currently being debated in Congress would ensure that you and your doctor are the ones making decisions about your health. The majority of working Americans will continue to receive their health care through their employer. In addition, health care reform will strengthen Medicare by eliminating billions of dollars in waste while lowering prescription drug prices.
But of course AARP is one organization and this only addresses some of the issues that are out there. Let’s look at the scary myths one by one: Below I’ll look at the 16 most annoying myths out there, what the truth is and so you don’t have to take my word for it I have also cited the sources I have used to research each myth and each truth.
Myth 1:
If the bill passes, approximately 114 million Americans are expected to leave private health insurance. Why? Their employers will drop the insurance because the taxpayer-subsidized plan will be 30 to 40 percent cheaper.
Fact: Employers will not be able to offer the public option exclusively. They will instead be able to buy into an exchange where they can offer employees more than one option, including the public option. This is what all Federal employees already have.
Source: Jacob S. Hacker: Co-director of the Center for Health, Economic, and Family Security at U.C. Berkeley; a fellow at the New America Foundation; and the editor of Health at Risk: America’s Ailing Health System–and How to Heal It.
Myth 2:
The public option will eliminate private insurance and erode employer-sponsored coverage.
Fact: The House bill actually increases the number of people who receive coverage through their employer by 2 million (in 2019) and shifts most of the uninsured into private coverage.
Source: Congressional Budget Office, July 2009, Coverage Tables
Myth 3:
If you don’t have private insurance the year that this bill is passed, you can’t get that later on from your employer.
Fact: Section 311 of the tri-committee House health care reform bill allows employers to meet coverage requirements by offering employees “coverage under a qualified health benefits plan (or under a current employment-based health plan.
The bill defines a “qualified health benefits plan” as “a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option.” Title I of the bill does not prohibit employers from enrolling employees in private plans.
Source: HR 3200, America’s Affordable Health Choices Act of 2009
Myth 4:
The Public Option with Drive private insurance out of business.
Fact: The report by the nonpartisan Congressional Budget Office said the public option proposed by Democrats would not drive private insurers out of business and most people would still choose to get their medical coverage through employers. Republicans often Site the Lewin Group as a source to propagate this myth. Lewin Group, which is a wholly-owned subsidiary of UnitedHealthCare.
Any individual insurance policy (as opposed to a group insurance policy) that is in effect today will be permitted to remain in effect; however, any new [individual] policies issued after the law becomes effective will be required to comply with the standards set out in the section relating to policies offered via the new Health Insurance Exchange. It’s grandfathering, not elimination. The report by the nonpartisan Congressional Budget Office said the public option proposed by Democrats would not drive private insurers out of business and most people would still choose to get their medical coverage through employers. Republicans often Site the Lewin Group as a source to propagate this myth. The Lewin Groupis a wholly-owned subsidiary of UnitedHealthCare.
Any individual insurance policy (as opposed to a group insurance policy) that is in effect today will be permitted to remain in effect; however, any new [individual] policies issued after the law becomes effective will be required to comply with the standards set out in the section relating to policies offered via the new Health Insurance Exchange. It’s grandfathering, not elimination.
Source: HR 3200, America’s Affordable Health Choices Act of 2009 and CBO Report, July 2009
Myth 5:
It will ban private health insurance for individuals. Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
Fact: It doesn’t outlaw private insurance. “There will be individual policies available, but people will buy those policies through the national health insurance exchange,” she said. The House bill allows for existing policies to be grandfathered in, so that people who currently have individual health insurance policies will not lose coverage. The line the editorial refers to is a clause that says the health insurance companies cannot enroll new people into the old plans.
Individual private health insurance means coverage that someone buys on his or her own from a private company. In other words, it’s for people who can’t get coverage through work or some other group, and the rates tend to be much higher.
Background: Page 16 defines what coverage will be considered “grandfathered coverage”; that is, coverage in existence today which would not be in compliance with new standards imposed by the law.
What it says: Any individual insurance policy (as opposed to a group insurance policy) that is in effect today will be permitted to remain in effect; however, any new policies issued after the law becomes effective will be required to comply with the standards set out in the section relating to policies offered via the new Health Insurance Exchange.
What it does: The purpose of the provision is to bring policy offerings into line with the minimum benefit tiers and provisions required under the new law
Source: HR 3200, America’s Affordable Health Choices Act of 2009
Myth 6:
5.6 Million illegal immigrants will be covered by ObamaCare. In another form: All non-US citizens, illegal or not, will be provided with free healthcare services 5.6 Million illegal immigrants will be covered by ObamaCare. In another form: All non-US citizens, illegal or not, will be provided with free healthcare services
Fact: Illegal immigrants are specifically excluded from coverage. Of course, this means that they will be continue to get their healthcare from expensive emergency rooms, so that may not actually be a good thing.
The section on page 50 of HR 3200 aligns Health Insurance Exchange policies with other laws currently in effect, such as the Public Health Service Act, State law, and ERISA. Health care cannot trump other laws already in effect.
According to America’s Affordable Health Choices Act of 2009, Page 143, Line 3, Section 246: “No Federal Payment for Undocumented Aliens. Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”
Source: HR 3200, America’s Affordable Health Choices Act of 2009
Myth 7:
Some people won’t be covered.
Fact: All people will have the opportunity to be covered, either via employer-provided plans or via the Health Insurance Exchange, which includes the public option. Those who opt out of coverage will be required to pay a penalty, which will be deposited to the general fund maintained for the public option. The penalty is intended to offset the cost of “adverse selection”; that is, those who opt out when healthy and later opt in at the point of illness or diagnosed chronic conditions. (Page 167 of HR3200, Title IV, Subtitle A, Part I, Sec. 401). The only group excluded will be illegal aliens.
Source: HR 3200, America’s Affordable Health Choices Act of 2009
Myth 8:
The Democrats propose “a government-controlled health care plan that will deprive roughly 120 million Americans of their current health care coverage. Two out of three Americans who get their health care through their employer would lose it under the House Democrat plan.
Fact: This report is from the Lewin Group, a health care consulting firm which is a wholly-owned subsidiary of UnitedHealthCare, an insurance company that obviously has a vested interest in suppressing a public option.. The report ran a number of scenarios, including what would happen if the government offered a public option that was a Medicare-style plan open to everyone. Their model found that 118 million people would choose to drop their private coverage in favor of cheaper public coverage.
In addition, the Congressional Budget Office (CBO) estimates that about 11 million people will end up enrolling in the public option.
Source: Congressional Budget Office, July 2009, Coverage Tables
Myth 9:
The American healthcare system is the best in the world.
Fact: 1 in 10 Americans can’t count on their healthcare coverage. America is ranked 37 in the world behind such countries As Columbia, Singapore and Morocco. France is rated at number one, followed by Italy.
Pew Research center did a study that said (among other things): Just 15% say health care in this country is the “best in the world,” while 23% rate it as “above average”; about six-in-ten (59%) view U.S. health care as either “average” (32%) or “below average” (27%).
Source: The Pew Research Center for the People and the Press’ May 2009
Myth 10:
Under Obamacare there will be rationing of healthcare, which we don’t have now. or, in another form: YOUR HEALTHCARE IS RATIONED!!!
Fact: Healthcare is rationed now. Insurance companies determine what procedures they will cover, and at what price. They deny payment on certain procedures, which means thay patients either go without, or they pay themselves. This is how rationing works in a capitalistic system.
Also: Referencing Pg 29, HR 3200, from Viral Emails Page 29 refers to co-payments and caps on out-of-pocket expenses as part of the minimum benefits package. It is not addressing treatment or approvals or anything of the sort.
“Private insurance companies ration care to Americans every single day. They reject applications based on pre-existing conditions and family history. They rescind coverage after an illness has been diagnosed. Their premiums and deductibles are so high that millions of Americans are forced to delay care or declare bankruptcy due to high costs: - Media Matters Fact Check
Ezra Klein of the Los Angeles Times points out on his blog: “If you look at waiting times, you’ll see that relatively few Americans wait more than four months for surgery, which helps folks claim that America doesn’t ration care, and makes our system look pretty good on the waiting times metric. Here’s what they don’t tell you: When you look at who foregoes care, the international comparisons reverse themselves. About 23% of Americans report that they didn’t receive care, or get a test due to cost. In Canada, that number is 5.5%.”
Rather Than Waiting In Line, Americans Simply Do Not Get Care. As Ezra Klein argues in the Los Angeles Times, “although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of us who can’t afford care simply won’t get it.
Source: HR 3200, America’s Affordable Health Choices Act of 2009, Media Matters Fact Check, Los Angeles Times, April 2009
Myth 11:
We will have long wait times for healthcare services if we end up with a public option.
Fact: This doesn’t even make sense. Are we suddenly going to have a shortage of doctors? Is everyone going to make a mad rush to the physician’s office? This is usually tied to an anecdotal report from Canada. The reality is that wait times vary from area to area, as well as from service to service in Canada, but it’s rarely as bad as reported. The most recent GOP claims of waits in Canada for treatment of life-threatening illnesses have been debunked as well. An Aetna executive admitted in his 2007 report to investors that average wait times in the US to see a provider are 70 days, and up to 4 weeks for life-threatening conditions.
Source: Deborah Burger, RN, co-President of America’s RN Union, July 11, 2007
Myth 12:
Democrats are proposing a government controlled health insurance system, which will control care, treatments, medicines and even what doctors a patient may see.
Fact: Insurance companies already control treatments, medicines and what doctors a patient may see. The current healthcare bill prevents insurance companies from denying coverage or treatments because of pre-existing conditions. Health Care Reform is attempting to cover those who are being denied coverage under the current system, This is what is already happening with our current Health Care system. Republican Congressman Tim Murphy (PA) agrees:
MURPHY: Yeah and that brings up the point here that with regard to one of our big frustrations with insurance companies is they control the market place, they control what’s done, a lot of times doctors not making the decisions here. And you recognize the frustration.
Source: C-Span’s Washington Journal, Jul y 17th, 2009
Myth 13:
There will be a Government Committee that decides what treatments and benefits you get.
Fact: Referencing Pg 30, Sec 123 of HR 3200- This section refers to the creation of an advisory panel for purposes of determining standards for the minimum, intermediate, and premium benefits packages. One of the most common myths out there is that benefits/treatments/etc will somehow be “rationed” by the government. In fact, the idea behind this commission is to bring together the different actors who are involved in provision of treatments and benefits to determine what should be deemed a “basic” benefit and what should fall into other tiers. Again, this section simply creates a panel who gives recommendations to the Secretary of HHS.
Source: HR 3200, America’s Affordable Health Choices Act of 2009
Myth 14:
There will be a Government Committee that decides what treatments and benefits you get.
Fact: Referencing Pg 30, Sec 123 of HR 3200, This section refers to the creation of an advisory panel for purposes of determining standards for the minimum, intermediate, and premium benefits packages. One of the most common myths out there is that benefits/treatments/etc will somehow be “rationed” by the government. In fact, the idea behind this commission is to bring together the different actors who are involved in provision of treatments and benefits to determine what should be deemed a “basic” benefit and what should fall into other tiers. Again, this section simply creates a panel who gives recommendations to the Secretary of HHS.
Source: HR 3200, America’s Affordable Health Choices Act of 2009
Myth 15:
Health Care Reform will hurt Small Business
Fact: The current draft bills also include a tax credit for small businesses that provide health care coverage for their workers. This benefit will make it easier for small businesses to provide coverage. Together with the exchange, these reforms will help small firms’ bottom line, allowing them to focus more of their attention on running their business and creating jobs.
The Senate’s HELP Bill also addressed this issue. From the July ‘09 version:
Choice of public and private plan, for uninsured, small businesses with less than 25 employees, and those with a premium share over 12.5% of their income.
Small Business Credits – employers with 50 or fewer full-time workers who pay 60 percent or more of their employees’ health insurance premiums will be permitted to receive tax credits for subsidizing coverage. Credit amounts are based on the type of employee coverage, the size of the employer, and the proportion of time the employer paid employee health insurance expenses, and are available for up to 3 consecutive years.
Self-employed individuals who do not receive credits for purchasing coverage through the Gateway are eligible.
Small Business Program Credits. Beginning in 2010, eligible. Employers required to pay 60% of premiums or be assessed $750 for each full-time employee not covered and $375 for each part-time employee not covered.
Source: HR 3200, America’s Affordable Health Choices Act of 2009, Senate HELP Committee Legislation
Myth 16:
Health Care reform will pressure the elderly to end their lives prematurely. Or in another form: It will allow for legalized physician-assisted suicide.
Fact: The section of the bill this myth is referring to is SEC. 1233. ADVANCE CARE PLANNING CONSULTATION: It amends the Medicare Act to allow coverage for patients to receive counseling about end-of-life care options every five years if they so choose. Moreover, prominent medical societies have supported such counseling. Here is an analysis of this portion of the bill: Provides coverage for consultation between enrollees and practitioners to discuss orders for life-sustaining treatment. Instructs CMS to modify ‘Medicare & You’ handbook to incorporate information on end-of-life planning resources and to incorporate measures on advance care planning into the physician’s quality reporting initiative.
The section of HR 3200 will require that doctors ask patients their preferences when it comes to end-of-life and critical emergency care situations. You get to choose whether you want doctors to perform life-saving treatments, or whether you want a Do-Not-Resuscitate order, or whether you want only palliative treatments and hospice. Under no circumstances would you be forced to sign away your rights or even answer when asked about your preferences, and under no circumstances would you be denied life-saving treatment if you wanted it.
Source: HR 3200, America’s Affordable Health Choices Act of 2009, CMA Analysis
Healthcare reform deserves an honest look at the facts. Some folks may disagree with the proposals, but lies and myths and shouting out civil discourse is not the way to ensure a thoughtful national debate. I hope that by carefully addressing some of the most volatile myths being circulated, this blog will help towards the goal of an appropriate policy debate.
Recently mortality has weighed heavily on my mind. Not in a morose way, but not in a detached philosophical way either. I’ve become more in tune with the reality of my mortality and that of those around me and how the paradigm of mortality I have built for myself to feel safe in both my life and my death is not an objective or subjective reality but a contrived mechanism to compartmentalize my life and create a tolerable scenario so I do not have to face those things that scare me the most.
A few events over the course of the year have caused me to reflect on the tidy little world that I created for myself so that I wouldn’t have to face my worst fears- being alone, old and poor.
But for me, and all of us for that matter (with the exception of the Gates family and the Walton family and some of the former Wall Street masters of the universe who probably don’t have to worry about being poor), there is always the possibility that someday we may be alone, old and poor.
I was recently asked by a friend why I have the dedication I do as an HIV/AIDS advocate. It was a generous question because there are many with more dedication than I. My answer was that I am motivated by anger.
But it made me think about my life and my choices and the life paradigm that I have built and how that paradigm has shifted.
As I thought about that a little more- I recognized that my anger is always a very thin veneer for what lies underneath- fear and loss. Fear of my own mortality I suppose. But I am not afraid of death, not because I believe in heaven or have any conception of an afterlife, but because the idea of “dust to dust” is intriguing more than scary and it is one of the most natural parts of life. The fear surrounding my mortality has been more a fear of leaving those that I love. The thought of leaving them is intolerable. So I mask that fear with anger and address all of that with activism.
It seems odd that the very illnesses that would usually make one confront one’s own mortality- the illnesses that you carry in your body- are the very illnesses that are central to my advocacy- AIDS and Hepatitis C. True advocacy is a way to deal with anger, but I realized that it has a more subtle context than that for me. I can no longer do the one on one, personal advocacy that I did when I was a Shanti volunteer 20 some years ago – I don’t have the emotional stamina, but I revel in public policy and planning. I have found the perfect way to address my fears through a veil of anger and then channel that anger into the least emotionally risky activity.
Advocacy at the public policy level allows me to deal with HIV/AIDS and Hepatitis C but to detach from the personal emotions about living with these diseases most of the time. I get to work on the issues- but in an intellectual way that is guided by compassion and passion but keeps it away from the inner most issues that I personally face with the diseases. I’ve found a comfortable little way to ensure I feel like I am being emotionally honest (the compassion and passion part) but really I haven’t been that emotionally honest with my own self.
A few things happened over the past number of months that made me confront the mortality of those who I love. My beloved beagle Darwin was attacked by a pit bull and although his wounds were not life threatening it put his mortality front and center. It had been lurking in the recesses of my mind for some months because he is getting older (11 ½ years old) but I brush those thoughts out of my head. I’m like the little boy sticking his fingers in his ears and saying “LALALALA- I can’t hear you” to my inner voice. But that event confronted me more with the knowledge that he will someday die. It was not comforting and I don’t think that there will ever be anything comforting about it.
More recently Lee who is the love of my life, my partner and best friend of 21 years was diagnosed with prostate cancer. For a while I dealt with this news by going through the motions of what a spouse does- making sure we take care of everything he needs and to be by his side as he went to doctors’ appointments and to give him the opportunity to talk to me, or not, about how he feels and what course of treatment he wanted to take. I focused on him and will continue to do so as he faces the next steps of his treatment.
But now as the second portion of the treatment is about to begin- radiation- cancer is more than a word to me now, it is a reality. Yes I knew Lee was diagnosed with cancer and that was hard, but as he starts radiation- that cancer is not as abstract- it has found a way into our everyday lives that cannot be ignored. My medications do the same, but I’ve gotten used to that and there is a big difference between throwing a handful of pills down your throat than radiation- even if those pills can have miserable side effects. Radiation therapy is another level of disease treatment and I am slowly coming to the terms that cancer is in our lives.
I have had many friends who have said- “Well if someone’s going to have cancer, it might as well be prostate cancer”. Thanks a bunch for that support. He has cancer and 22,000 men die of prostate cancer every year. And every time doctors say that his cancer is aggressive I cringe. So now I am coming to terms with Lee’s mortality too.
For 21 years I’ve lived under the delusion that I would not have to be the one to eventually be left alone. After all I have HIV/AIDS and Hep C. It was comforting in a twisted way. I have abandonment issues, we all do. Maybe mine are a little more acute because of my mother’s suicide, but they are significant for me. Before I met Lee the way I dealt with those issues was to push people away before they would leave me- not the healthiest way to deal with one’s feelings. Through my love for Lee I have learned that pushing people away is selfish and led me to be alone which ironically is my darkest fear. Now I can’t dream of pushing people away. But maybe the paradigm that I have set up is exactly that. I can begrudgingly accept living a life where I die first, but even contemplating one where I am left alone is intolerable. Isn’t my comfort with dying first analogous to pushing people away before they leave me?
So I no longer have the intellectual constructs in my life that I have built to protect my heart. I am now slowly confronting the fact that I may indeed be alone and if I am alone when I am old- I will likely not be in the best of financial shape.
Having been on disability for a long time is not the best way to save for one’s retirement. I’m seriously thinking about returning to work full time for the first time since I left working almost 10 years ago. There are many factors to consider- not the least is risking the safety net of my long term disability policy (the source of the bulk of my income) for 12 -24 months. So going back to work may mitigate being thrust into abject poverty when I am older and automatically lose that long term disability income at 62. But it doesn’t mitigate the possibility of being alone.
I don’t dwell on the possibility of my mortality, nor on Lee’s and Darwin’s for that matter. But on drizzly, grey, chilly November San Francisco mornings at 5:30 before the sun comes up, those thoughts can take hold. That’s especially true when you look over at the man who has caused your soul to swoon and the dog who has captured your heart slumbering peacefully in bed and think about losing them.
I am less scared though. Oddly, by occasionally thinking about it, I am able to address it better both practically and emotionally and that is liberating. I’m not paralyzed by fear.
Too often we are motivated by fear. Clearly that is how the right wing has manipulated public policy debates for eons. I remember the resolve that I had when Lee and I travelled to Europe on September 20th, 2001- just 9 days after 9/11. Friends and family told me that I was nuts that they would be too afraid to travel. My retort was that ‘s what terrorist do- they terrorize you into paralysis and through fear cause you to act in ways that compromise your convictions, your integrity and your values (torture comes to mind)
Am I afraid of death? No, Am I afraid of life alone? Yes, but I am beginning to be less terrorized by it and I am no longer paralyzed by the possibility. In my own personal way, each and every day, I try to better understand myself- what motivates me, why I do the things that I do and have the feelings I have. I now feel that my soul knows what I knew intellectually – motivation by fear is toxic and that confronting that fear is oddly liberating.
2 Comments
Posted in Blogroll, Democrats, Faith, Gay and lesbian issues, Liberal blogs, Religion, Social and Political Commentary, Social and Politics | Tags: cancer, death, Dogs, fear, Healthcare, HIV/AIDS, HIV/AIDS Advocacy, life lessons, loss of family, loss of pets, pets, philosophy, prostate cancer, suicide