The Universal Health Coverage Bogeyman
Universal Health Coverage is coming! Universal Health Coverage is coming! Get out your guns! There is an enormous amount of fear mongering going on around the issue of Universal Health Coverage (UHC). From the UHC advocates, we hear about scary medical bankruptcies. From the UHC opponents, we hear that this is just a way for the government to run our lives. In fact, that last article was sent to me by an old college friend. “Is this the health care bill you want?” she asked. (Peter Fleckenstein (aka “the fleckman”), the creator of this “analysis”, posted a complete copy on his blog.) Well, if its as bad as the tweet-filled weblog post makes it out to be, no, I don’t want it. A couple of points.
- Mr. Fleckenstein and many reactionaries harbor a deep suspicion of bogeymen such as ACORN and illegal aliens. These bogeyman don’t scare me. I will totally ignore those sections of the criticism. I don’t care if the government supplies health care for members of ACORN. And even illegal aliens are people who sometimes need health care. Which part of “Universal” did you not understand?
- The bill being referred to, HR 3200 — “America’s Affordable Health Choices Act of 2009” — is over 1000 pages long. I don’t have time or interest to read every page. What I do have time to do is fact-check statements about the bill that I find alarming. Good thing “the fleckman” provides direct pointers.
- This is the House bill. The Senate bills up for consideration aren’t finished. One doesn’t include a government-run plan — something that seems to be the biggest sticking point for many of the article’s complaints. I am personally more comfortable with the “co-op” idea of the Senate Finance Committee’s bill — it sounds similar to Germany’s version of UHC.
With that in mind, lets look at a few claims:
- There will be a government committee that decides what treatments or benefits you get. (Sec. 123) The actual text says: “Committee to recommend covered benefits and essential, enhanced, and premium plans.” There is a big difference between a recommendation and a decision. As far as I can tell, no one is going to stop you from paying for extra treatment if you want it.
- Your health care is rationed!!! (p 29 ln. 4-16) The actual text referenced here has nothing to do with rationing health care, but with how co-payments on the public option will be adjusted.
- Government will have “real-time” access to individual finances. (sec 163) This is a modification of the onerous HIPAA regulations. The addendum the bill puts in does, indeed talk about “[enabling] the real-time (or near real-time) determination of an individual’s financial responsibility”. But again, this isn’t mandating access to your individual finances. Instead, it seems to be saying that they want universal standards for determining a co-pay or your liability for a specific treatment or office visit instead of the current system — which involves multiple rounds to the insurance company.
- Government will have direct access to bank accounts. (sec 163) The actual text here: “enable electronic funds transfers [for] … health care payment and remittance advice”. This isn’t government access — this is the access for the health care provider. And enable processing isn’t the same as forcing individuals to surrender information.
- Government will tell doctors how much they can charge. (sec 225) Just like they set payment levels for Medicare and Medicaid. Doctors are not obligated to accept the government plan. If you want health care from a doctor who doesn’t accept the government option coverage, then you can get it, provided you can find a way to pay for it.
- Employers must enroll employees into the public plan. (sec 312(a)) This section is talking about how an employer can meet the government requirements. One of the requirements is “automatic enrollment”. Part (c)(2) of this section explicitly states that an employee may make “an affirmative election to opt out”. And the plan doesn’t have to be the government option. If the employer offers adequate private insurance, then they meet the criteria.
- States give up some of their State Sovereignty. The horse is long ago out of the barn. When my friend and I were in college in New Orleans, there were news stories about a drinking age being imposed on the Quarter. Previously, it was illegal to buy alcohol if you were under 18, but not to sell it to anyone under 21. This makes an incredibly hard law to enforce. The federal government, in order to bring Louisiana into compliance with the rest of the country’s drinking laws, threatened to withhold federal money for roads if the laws weren’t changed. You can argue that this infringes on a state’s sovereignty — but no one is forcing the state to take the money. If it wants it, it has to change. If it is willing to fund its own road system entirely, it can leave the laws as is. This is a pattern the federal government has repeatedly followed when dispensing federal money. It has withstood Supreme Court challenges on the basis that it infringes a state’s sovereignty. But the state, if it really wants to be sovereign, can opt-out of the federal money.
The fear-mongering continues, but I’ve got to get to bed. The pattern I see here is that Mr. Fleckenstein is skimming (understandably) the 1000+ pages of regulation looking for alarming phrases and not bothering with the context. He ignores other parts (like the religious conscience exception on p170) completely.