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1. Freedom to choose what's in your plan
Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.
This I would say is a fair critique, to a point. The good intention: making insurance companies cover people's afflictions in a fair, substantive manner. Obvious big government drawback: special interests will push through their own agendas so that some unnecessary things are included. This is no great insight, and it is an unfortunate cost. But two points.
One, though it be a truism, no plan will be perfect. We will simply have to accept some inefficiencies. Two, some of these higher costs and inefficiencies will hopefully be addressed by the independent committee of experts proposed to be assigned to present an annual report on ways to cut costs, and unlike past committees similar in nature, Congress will be required by law to vote for or against their recommendations, giving the committee some teeth.
What I don't think is that this drawback serves as a significant loss of freedom. The article suggests:
The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.
This seems a bit of a non sequitur to me. Because plans are required to provide certain benefits, they will not be able to compete based on the other things that they offer at competing costs? I think there may be some cost increase, considering increasing minimum benefits entails a higher minimum cost, and thus less of an option for more benefits under a cost constraint. But that's in a vacuum. Certainly the presumption could be that the public plan and other reforms will lower costs in other ways sufficiently to offset the possible increase above. Obviously I don't have the economic analysis before me, but I am certain that my analysis is no less formal than the article I'm working with, so I won't worry too much.
I agree the "standard benefits packages" may cause some inefficiencies, but I don't buy them creating any significant loss of freedom. Moving on.
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2. Freedom to be rewarded for healthy living, or pay your real costsThis is in some fashions, I suppose, a loss of freedom. But I think the issue is complicated when one takes a long-term and wholistic perspective. People age; the young become old. As such, as per the above argument, the young will then get to the point where their insurance rates become the lower, more subsidized ones. It is far from irrational for a society to decide that the most efficient way to provide health insurance to all its citizens is to place more of the cost on the young than the old, considering that the economic circumstances that the young enter into our the result of the efforts of past generations, that is, the elderly that their higher rates subsidize.
Americans with pre-existing conditions need subsidies under any plan, but community rating is a dubious way to bring fairness to health care. The reason is twofold: First, it forces young people, who typically have lower incomes than older workers, to pay far more than their actual cost, and gives older workers, who can afford to pay more, a big discount. The state laws gouging the young are a major reason so many of them have joined the ranks of uninsured.
If society tends to force the elderly to retire and lose their income to the young who enter into the ranks of the employed, then there must be a mechanism by which the elderly are compensated by the system and supported, in return for their previous input for society. That is not to say that this system will be perfect, considering we are restricted from considering a single-payer system, which would open up better possibilities for dealing with this issue. But this so-called loss of freedom must be viewed through the perspective that we necessarily give up certain freedoms to secure greater goods and efficiencies within the social contract. This is perhaps one of those instances. So, in strict terms, yes, this would be a loss of freedom, but it is a voluntary loss, decided upon through the mechanisms of democratic republicanism, violating no inviolable rights. Only strict libertarians can object to such a point, and a majority of the American public has not embraced such a political philosophy.
One last thought on that point. It does say:
Under the Senate plan, insurers would be barred from charging any more than twice as much for one patient vs. any other patient with the same coverage.
So then to claim that the reforms "would ban insurers from charging differing premiums based on the health of their customers" isn't exactly accurate. There is some leeway to charge different rates, though of course it will be admitted not full leeway. But we dealt with that point above.
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3. Freedom to choose high-deductible coverageI don't really have a great answer for that. One thing though is the very cautious phrasing. "Seriously endanger." "Could do it." "After the bills are passed." That makes it sound uncertain, but the author is clearly quite biased enough to not mention the alternative possibility and the chances of and factors involved in each. And it certainly doesn't satisfy the highly inflammatory title of the article, which is not ambiguous or qualifying in its claim. So I will move on from this one, not having read much on this specific aspect of the plan and having undercut its credibility anyway.
The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. "The government could set extremely low deductibles that would eliminate HSAs," says John Goodman of the National Center for Policy Analysis, a free-market research group. "And they could do it after the bills are passed."
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4. Freedom to keep your existing plan
The bill gives ERISA employers a five-year grace period when they can keep offering plans free from the restrictions of the "qualified" policies offered on the exchanges. But after five years, they would have to offer only approved plans, with the myriad rules we've already discussed. So for Americans in large corporations, "keeping your own plan" has a strict deadline. In five years, like it or not, you'll get dumped into the exchange. As we'll see, it could happen a lot earlier.
I don't see how this is a new critique. As the author says, "with the myriad rules we've already discussed." As in, you'll have the same losses of freedom that I've already considered and critiqued. And actually, you get five years to put off this change, or reform, depending on your point of view. It seems to me that the author just wanted to get to five critiques. I don't see how this one has anything new to offer.
But even if it is a new critique, is it accurate and fair? I searched seriously for like an hour to find this article, because I knew that I had read something, somewhere about this. Finally found it at ThinkProgress in a post from July 16th, thus explaining the slight memory loss. Here's how they put it:
In fact, page 16 is the beginning of the section on “Protecting The Choice To Keep Current Coverage.” The section that refers to five years is on page 17, but it’s not about pushing Americans off their current health plans. As the summary on Rep. Pete Stark’s (D-CA) website notes, it simply “provides for a five year grace period for current group health plans to meet specified standards.”
So neither one is exactly untrue. It is at some point a matter of your perspective. I tend to side with the latter, but I am certainly biased. So you can either think of it as, yeah, you get to keep your coverage, crafted under the rules of the former system, but only for at most five years. Or you can say, we're reforming this system, and we want to solve it's problems, but we understand that we're in a recession, and people need time to adjust, so there are five years to do so.
And I also wanted to point this out, as a bit of a side note, from the same post by ThinkProgress:
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. By 2019, 30 million individuals would also purchase coverage from the Exchange, but only 9-10 million Americans (or approximately 1/3) would enroll in the public option, the rest would enroll in private coverage.
This is another critique, not necessarily presented here, but I still thought I'd mention it as long as I was linking to the article. Plus, it does show an increase in freedom I think, at least by the author's standards. Moving on.
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5. Freedom to choose your doctorsThe Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.
Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.
Alright, lots here. To be honest, I had not heard of the medical homes before, so I had to do some searching, and it certainly wasn't something that came up quickly in a google search. And if it's not coming up, my first instinct is not to trust it, because, as Media Matters of America has shown, negative coverage of the bill has outweighed positive coverage by about 100% in the debate on health care in the mainstream media. So if I can't find the critique, then it's probably not really being made, and any critique that can be found is out there, reasonable or not. So that's my first qualm about it.
Here's what J. James Rohock had to say, the President of the American Medical Association:
New models of care like the medical home, where patients have one physician coordinate care across many specialties and settings, benefits patients and rewards doctors for focusing on aspects of care that are vital but less tangible than procedures. This is the type of care physicians want to provide and patients want to get.
So, it's not clear to me that it is a requirement that people now operate through the medical home program, and honestly, I haven't read anything about that, and I read a lot of commentary. So I don't exactly know what to make of it. The context of the NYT times piece from Rohock seems to suggest that it's just one new method that will only be one option or part of the health care reform. Plus, it certainly doesn't suggest that you don't get to choose your own doctor to coordinate care, e.g., your current doctor. And the author of the article doesn't ever cite where this comes from in the legislation. So I really just don't trust it. I don't have any more substantive argument about medical homes themselves. Here's one thing from Knowledge@Wharton, the online business journal for UPenn's prestigious business school, that I found that could lend itself to the article's argument:
The various health reform scenarios being debated on Capitol Hill place some emphasis on bolstering primary and preventive care. The idea -- a familiar theme heard especially in the early days of HMOs -- is that if everyone had a so-called "medical home" with a primary care physician, they would be more likely to get timely and preventive care, thus avoiding more costly trips to specialists and emergency rooms. Uninsured Americans don't necessarily go without surgery or care when they get sick -- but they may put off treatment or be seen by a doctor in the emergency room instead of the doctor's office.
But that isn't very clear either, and certainly doesn't make anything sound certain. I'm going to have to file this claim under another failure to meet the standard set by the article's own title. You will, no wait, maybe lose 5 key freedoms.
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So that's what I got. Certainly my longest blog post ever. What do you think? Where do you disagree with me? I simply don't find much credibility here. Show me more proof, please. It's an online article. The internet has made it so easy to cite sources and show where you get your information. It's not here. So I'm unconvinced. I'd love someone to supplement the argument. But at this point, I reject almost all of it as unsupported or wrong-headed. But I've certainly enjoyed this exercise, and hope for some feedback and improvement.
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