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Docs and Insurers Left Out of Health Care "Reform"

By Greg Scandlen

Most of the Washington interest groups have been expressing support for "health care reform" so as to ensure they get "a seat at the table" and defend their interests. They want to be "on board before the train leaves the station," and other such idiotic ideas.

Keep in mind that it was precisely Kennedy's staff they have been meeting with.

Now, in spite of such groveling, Senator Kennedy's staff has released a rough draft of the bill he intends to introduce. I've read the whole thing, but Keith Hennessey beat me to the punch in writing up a short description, linked here. I'll just add some emphasis.
Let's start with the most cynical of all the manipulations in the bill. It starts out on page two with a "Declaration of Rights."

It is the right of patients to select the doctor of their choice.

A strong doctor-patient relationship is essential to the practice of medicine, and patients have a right to an effective doctor-patient relationship.

Doctors and other health professionals have the right to judge what is best for their patients.

Nothing in this Act or the amendments made by this Act interferes with the rights described in this section.

Sounds great, doesn't it? And if you believe any of this, there is a bridge in Brooklyn you should invest in. In fact, within the first 10 pages all of these "rights" are nullified. On page 8, qualified health plans are required to "develop and implement a reimbursement structure that provides incentives for: case management, care coordination, disease management, discharge planning, best clinical practices, evidence based medicine, and wellness and prevention activities." And they are required to do all this while following the payment policies of the Medicare program.

So much for the AMA's seat at the table.

Insurers aren't faring much better. Oh sure, they are getting a mandate that requires everyone to buy what they sell. But they are required to stay within loss-ratio minimums, even while managing physician behavior, provide federally dictated benefits, offer coverage without any annual or lifetime maximums and OOP limits based on the HSA standards, and use community rating with only an age adjustment. There will be no adjustments for behavior or gender, and in fact there appears to be no provision for denying coverage based on non-payment of premiums. They will also have to continue covering "children" to age 27, without any requirement that the "child" still be living with his or her parents. Oh, and their "marketing practices" will be regulated by the federal government.

Boy, that seat at the table worked out great for AHIP, didn't it?

Of course, NAHU fared even worse. There will be no brokers or agents in Mr. Kennedy's system. Instead, the state "Gateways" (the new term for insurance exchange) will contract with "navigators," which will "conduct public education, distribute fair and impartial information, and assist with enrollment." The navigators may be unions, trade groups, or "other entities" (maybe like ACORN). Commissions are not allowed.

Employers wanted a seat at the table to avoid an employer mandate. Guess what? Yep, they got a mandate and also a new restriction on ERISA that prohibits any employer with fewer than 250 employees from self-funding.

But the people who really get the shaft in this system are consumers and taxpayers. The government will create a massive new regulatory structure that will all have to be paid for by the taxpayers, and taxpayers will also be providing free Medicaid coverage for everyone up to 150 percent of poverty and subsidizing everyone up to 500 percent of poverty -- that means a family of four making $110,000 a year. Other people will be required to have insurance coverage at all times and under all circumstances. To enforce this and to determine how much of a subsidy you might be eligible for, the government will combine all of its health information technology with income information from the IRS and the Social Security Administration. Now, if you have a financial reversal and your income drops, you may be able to get a "hardship deferral" ... but you will have to apply to the federal government for it.

Ain't this fun? Aren't you feeling well-represented by all those seats at the table?

Read the Opposing Views debate, Should the U.S. Have Universal Health Care?


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