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.

  1. 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?
  2. 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.
  3. 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.

10 thoughts on “The Universal Health Coverage Bogeyman”

  1. Great post Mark. I am amazed by the conclusions at which people arrive concerning UHC, based upon rather flimsy (or even wholly made up) evidence. Thanks for shining the light of truth on this particular one.


  2. Nice post

    I am often amazed at how susceptible people are to fear-mongering and propaganda, especially when it leads them to take a position that is actually contrary to their best interests. I wish everyone took the time to do this kind of analysis. -Shannon

  3. Reply Universal Health Care Coverage

    Hi Mark,

    Thanks for your analysis of my tweets, I think.

    You tell everyone that you haven’t read the entirety of the bill. Not only have I read the bill in it’s entirety, page by page, line by line, I’ve also read the references to the Social Security Act, the IRS tax code, The United States Code, The Public Health Services Act, etc. included in the bill.

    I would suggest that for you to do any credible analysis of what I have said, you would have to actually read the entire bill. Until then your analysis is merely speculative.

    Additionally – Don’t take my word, just listen to Barry and friends tell you that Universal Health Care and the destruction of private insurance is exactly what they want:

    1. Re: Reply Universal Health Care Coverage


      I really don’t care if private insurance is killed off. Why should that bother me? Jobs? My type of work (computer programming) takes away jobs every day. The web is destroying jobs. Innovate or die. This is like corn farmers complaining about a backlash against ethanol.

      If there isn’t a need for something (e.g. private health insurance, steno pools, ethanol in gas) then it should disappear.

      I’m not trying to do an analysis of the whole bill. I very clearly stated that. I’m simply fact-checking some of the most alarming statements you made.

      I checked your twitter feed and it looks like you got lots of response. In each case, instead of providing references to back up your point of view you said (essentially) “Have you read the whole thing? No? Well, I have!” This is not a credible argument for your point of view.

      If your interpretation is correct, then point me to supporting statements. The statements you made are frightening, but when I check them against the sections you point to, they have no support. I’m lead to believe you’re just making alarmist statements. This is no different than many Democrats ceaseless complaining that Bush “stole the election”.

      I suspect that just like we continue to hear that Bush stole the election, we’ll continue to hear how any UHC is trampling our rights. And barcodes are a mark of the beast.

      Frankly, I’ll be extremely surprised if you can show from the legislation any support for your point of view. I suspect you’ll just fall back on the defense that you’ve read it all and you stand by your statements. That’s just a reassertion of your previous statements and means nothing — I’ve already pointed out how those statements fail.

      If you are so familiar with the legislation, then it should be no problem to pull up more examples to defend your interpretation. I’m waiting.

      1. Re: Reply Universal Health Care Coverage

        Like I said Mark until you’ve read the bill in it’s entirety like I have you can’t as you say fact check anything.

        You want references? LOL! I’ve provided hundreds.

        Your feeble attempts at trying to pigeon hole me into a group is just that. Feeble.

        When you’ve read the entire bill, get back to me.

  4. VetsOnTheWatch Reply

    It’s good that the debate goes on. Civil, point and counter point.

    My counter-point to the businesses providing coverage. Yes, they can opt to not provide the public option. If they have a payroll of 250K – 400K, they will pay a tax o 2-6%. Over 400K the tax is 8%. Who will want to expand business? No one.

    States give up sovereignty you reply that horse is out of he barn. So, I guess, we just scrap the 10th amendment and let even more of that power go right to the fed? Not if I can help prevent it.

    Doctors get a set fee just like Medicare and Medicade. Excellent point. Many of the doctors are leaving that system because they cannot survive making less than cost. And if they do not enroll, they get penalized.

    Everyone feels that reform is needed. But please name one program run by the government that is not a behemoth, money-wasting, controlling endeavor?

    1. Re: VetsOnTheWatch Reply

      If you check the latest information on HR3200, you see that the small business mandates have been raised from 200k to 500k. A small point, but notable.

      The tax applies only to businesses who don’t provide any health care coverage at all. If the business provides private health insurance as an option for their employees, then they don’t have to pay it. (see Sec 312, p144)

      Where are doctors penalized for not accepting Medicare/Medicaid? I see other providers (nurses, midwives, etc) are mandated to participate, but not doctors.

      Everyone feels that reform is needed. But please name one program run by the government that is not a behemoth, money-wasting, controlling endeavor?

      You’re falling for the bogeyman trap. This bill (HR3200) is not the only bill on the table. It is being modified as we speak. Other bills (esp in the Senate) do not include the government plan. Where the plan is included, it does not eliminate your option to participate in private insurance if you can afford it.

      So, if you feel the “government option” in HR3200 is a waste of money and too controlling, you can purchase your own insurance.

      There are those — conservative Mennonites and Amish — who will see the government option as insurance and refuse to participate for religious reasons. The bill makes provision for them. And, just as those conservative Mennonite and Amish refuse to participate in Social Security, they will be able to refuse to participate in this plan.

      See, even for Social Security you have a choice. You’ve just refused to exercise it.

  5. Why so big? Not for Firefox 3.6a1pre

    Thanks for doing this.

    * Add-ons download reported a 16MB download and lib/ff35/ is 30MB; why so big? (rootkit, virus, ?? 🙂 )

    * Not surprisingly, it reports incompatibility with Firefox 3.6a1pre (the nightly builds I’m running). I can probably use Nightly Tester Tools or manifest hacking to force it.

    Did you post “just the diffs to the Google Gears list”? Someone named Scott Wolchok had diffs last year, I think he submitted them to and/or the gears-eng mailing list. Maybe Google Gears team will run out of excuses for amd64 with enough prodding from fine bystanders like yourself.

  6. personal observations about how the current system works.

    A medicare child sitting in a hospital bed for a couple days because Medicare would only cover the medication given with IV in the hsp. Other folks would have gone home with medication.

    An un-insured relative having medications reduced to ?save money? with the hope it would not increase symptoms. It did. Relative got sicker.

    Playing the spend it down and away game before elderly is in a nursing home under total Medicare coverage. The administration actually will tell the family how to not get drained completely dry. how to work around the system. Some listen and have some money afterward. Other did not and ended up having to wait on the gov’t lien on the property after the patient’s death to get everything settled.

    I’ve seen caps on coverage for mental health at 20-30 percent or maybe 50 percent of what is actually needed … and seen and heard of providers taking advantage of full coverage. Hey this kid has full mental health coverage!! so the teen stayed in the health unit because there was money – but the lowly social worker said, “He didn’t need it.”

    I’ve had good friends shoved out of the mental wards of the hsp. while still barely able to recognize their own face in the mirror because their coverage had played out. “So go to the state hospital if you think you need it.”

    With any coverage there are limitations, whether provided by the government or not. At this time the mental health wards in our state have dwindled to a handful. The rest simply could not cover the indigent. At the same time … others have figured out how to get the most out of the state run system for kids and flourish while making sure they get all they can.

    Something needs to be done. Something will be done, the difficulty is that as soon as it becomes an established fact, there will be those who take advantage of all of it, there will be others who need it and won’t be able to access what is really needed because they don’t know how to work the system.

    And yet, having seen my husband’s cost for a couple of prescriptions go up with the law mandating him to sign up for a select group of prescription coverage … I wonder how wonderful it all really will be in the end. When he went to sign up for the coverage (which I could have gotten through work for less overall) he was told it would cost him less. No difference, except now he has a monthly insurance bill.

    It won’t be all it is cracked up to be. there really is no such thing as a free lunch. Someone is paying the bill. Someone is paying for the higher standard of living for the providers of medicine and insurance and government care. That someone’s name is written on your 10-40 form and health care card.

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