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ObamaCare: Tightening the Noose Around Private Health Care

The U.S. Senate is making increasingly Byzantine backroom deals in an attempt to pass some form of universal health care by the end of the year. But even though the final bill isn't settled yet, one fact is becoming increasingly clear. Any plan they pass will result in the government seizing an unprecedented degree of control over previously private health spending decisions.

Two of these proposed new controls are worth highlighting, because they are not often discussed in most mainstream media reports.

First, the U.S. Preventive Services Task Force (USPSTF) will be setting the rules for what sorts of preventive health care insurance companies must offer.

According to Dr. Delia Chiaramonte, the proposed law states:

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force.

In other words, health insurers must pay for preventive services that the U.S. Preventive Services Task Force (USPSTF) recommends. Such mandated benefits will inevitably raise the costs of health insurance nationwide as they have already done in states like Massachusetts.

The USPSTF is also the government task force that aroused such controversy when it recently recommended restricting screening mammograms to women over age 50, even though professional medical societies such as the American Cancer Society and American College of Radiology have long recommended women undergo routine mammography starting at age 40, based on years of peer-reviewed medical research.

The USPSTF has been sharply criticized for basing its decision on old and unreliable scientific data. But there's also a more fundamental moral question of whether the federal government should be setting guidelines that essentially put a price on a human life.

The USPSTF argued that eliminating mammograms on women between age 40 and 49 would only result in one additional cancer death per 1,900 women screened -- a level they apparently considered acceptable. In contrast, they still supported mammograms for women over age 50 because that would prevent one cancer death per 1,300 women screened.

Hence, the government is saying that it's "cost-effective" to spend money for a mammogram that will save the life of a 50-year-old woman -- but not the life of her 48-year-old younger sister.

Second, government rules may make it more difficult for patients to receive medical care outside of government payment guidelines.

Sue Blevins of the Institute for Health Freedom notes the following:

Regardless of whether you agree or disagree with the U.S. Preventive Services Task Force's recommended changes for mammograms, its recent proposal raises important questions for all Americans: Do you want government panels making preventive health care decisions for you? And do you want government to outlaw private payment for preventive care? Government could end up with both powers under the health-reform bills being considered. ...

[T]he House version could prevent Americans from paying privately for covered preventive care. That's because H.R. 3962 states that there shall be no cost-sharing for covered preventive services. (The Senate bill includes a similar provision.) The definition of cost-sharing appears to include out-of-pocket spending. Thus without further clarification, this provision could be interpreted to prevent anyone from paying out of pocket for covered preventive care.

Similar restrictions against "cost-sharing" or out-of-pocket spending are already established policy for Medicare -- the federal government's "universal heath care" program for the elderly.

Under current federal law, if a doctor accepts Medicare patients (i.e., he is a "participating physician"), he must accept the payment set by Medicare. If the doctor can't make ends meet on the low Medicare fees, then that's his problem. Medicare rates are currently so low that many physician practices would go under if they had to rely solely on Medicare -- which is why many doctors currently limit the number of Medicare patients they are willing to accept.

But suppose a patient tells his doctor, "I know that Medicare doesn't pay you enough to cover your costs of performing the surgery which you and I both agree is necessary. I'll pay you extra in addition to Medicare to get it done."

By law, the physician cannot accept this offer. If he did, he could face stiff fines (or possibly jail) for illegal "cost-sharing." As long as he is a "participating physician" in Medicare, he may not accept any out-of-pocket money from his patients for covered Medicare services.

In theory, physicians and patients can opt out of Medicare. But the government makes that difficult for both parties. Health attorney Kent Masterson Brown warns physicians:

Under Section 4507 [of the 1997 Balanced Budget Act], if a physician provides even a single Medicare-covered service to a single self-paying Medicare beneficiary, that physician is completely barred from Medicare for a period of two years.

Participating physicians may not enter into self-pay private contracts with Medicare patients on a case-by-case or patient-by-patient basis.

Brown concludes:

[A]s Medicare's fiscal pressures mount Congress eventually will reduce provider payments, which will reduce beneficiaries' access to care. If and when that occurs, Section 4507 will deny care to Medicare beneficiaries, because it will prevent beneficiaries from going outside Medicare to purchase those services themselves.

Similarly, the government makes it extremely difficult for patients to opt out of Medicare. Seniors who choose to forgo Medicare benefits must also lose their Social Security benefits.

Sue Blevins notes:

[G]overnment regulations severely penalize seniors who wish to keep their private health insurance, rather than enrolling in Medicare Part A, the government hospital insurance program, upon turning age 65. Little-known administrative policies adopted by the government in 1993 and strengthened in 2002 say that seniors can't refuse Part A coverage unless they give up their Social Security benefits. Adding insult to injury, once enrolled in the program, the only way seniors can withdraw from it is to repay all Social Security benefits they received, as well as any hospitalization benefits Medicare paid on their behalf.

Few seniors can afford to forgo their Social Security benefits, especially after being compelled to pay into the Social Security system their entire working lives (rather than being allowed invest that money in their own private retirement accounts). Hence, this legal tie between Social Security and Medicare essentially locks all but the wealthiest seniors into the Medicare system. (This law is currently being challenged by a group of five senior citizens.)

Even though recent proposals to expand Medicare to patients between ages 55 and 65 appear politically dead, the provisions against "cost sharing" will remain in force for Medicare patients over 65 and would be new restrictions for Americans of all ages on services covered by the USPSTF.

And just as the USPSTF would be empowered to restrict services such as mammography, the Senate bill would establish an "Independent Medicare Advisory Board" to restrict payments "if Medicare costs grew faster than a certain rate." The exact details are still being hammered out, but any version with teeth would likely control spending through similar "cost-effectiveness" criteria as the USPSTF.

Such government restrictions illustrate the fundamental problem with any form of "universal health care." Anytime the government attempts to guarantee a service such as health care, it must also control it. Directly or indirectly, the government will increase its control over what care is covered, which patients may receive it, and how much treating physicians can be paid.

Under ObamaCare, patients will be forced to pay for certain kinds of medical care whether they want it or not -- thus raising their health care costs.

And patients may not be able to pay for some medically necessary care outside of government-set guidelines, even if they want to -- a clear violation of the rights of patients and doctors to contract for medical services on any terms they find mutually acceptable.

Even if American health care remains technically "private," the ever-tightening noose of government regulation will increasingly limit the freedom of patients to seek (and doctors to deliver) medical services based on their independent judgment of each individual patient's best interest. Instead, doctors will be forced to practice according to government guidelines that maximize some collectivist ideal of "cost-effectiveness."

The strands of the noose are being woven by Congress as we speak -- and about to be dropped around our necks. How far will we let them tighten it?