Healthcare Reform- Fact and Fiction

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.